section name header

Evidence summaries

Sulfadoxine-Pyrimethamine Plus Artesunate Versus Sulfadoxine-Pyrimethamine Plus Amodiaquine for Treating Uncomplicated Malaria

Sulfadoxine-pyrimethamine plus amodiaquine appears to be better than sulfadoxine-pyrimethamine plus artesunate when treating uncomplicated malaria. Local resistance patterns have to be carefully considered. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 4 studies with a total of 775 subjects. All were from areas of high and seasonal malaria transmission in Africa. Fewer participants using sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ) failed treatment by day 28 (RR 0.59, 95% CI 0.42 to 0.83; 652 participants, 3 trials) compared to those using SP plus artesunate (AS). Even excluding new infections, SP plus AQ performed better (RR 0.62, 95% CI 0.40 to 0.96; 649 participants, 3 trials). There was no statistically significant difference between the two treatments for treatment failure at day 14 (RR 1.14, 95% CI 0.47 to 2.78; 775 participants, 4 trials). SP plus AS was more effective at reducing gametocyte carriage at day seven (RR 2.31, 95% CI 1.36 to 3.92; 220 participants, 1 trial). Adverse events were poorly reported, but did not seem to differ in type and number between the two treatment combinations.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).

    References

    • Bukirwa H, Critchley J. Sulfadoxine-pyrimethamine plus artesunate versus sulfadoxine-pyrimethamine plus amodiaquine for treating uncomplicated malaria. Cochrane Database Syst Rev 2006 Jan 25;(1):CD004966. [PubMed]

Primary/Secondary Keywords