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EFFICACY OF TRIMETHOPRIM-SULFAMETHOXAZOLE COMPARED WITH SULFADOXINE-PYRIMETHAMINE PLUS ERYTHROMYCIN FOR THE TREATMENT OF UNCOMPLICATED MALARIA IN CHILDREN WITH INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS DUAL CLASSIFICATIONS OF MALARIA AND PNEUMONIA

In Malawi, trimethoprim-sulfamethoxazole (TS) is the recommended first-line treatment for children with Integrated Management of Childhood Illness dual classifications of malaria and pneumonia, and sulfadoxine-pyrimethyamine (SP) plus five days of treatment with erythromycin (SP plus E) is the recommended second-line treatment. Using a 14-day, modified World Health Organization protocol, children with dual IMCI classifications of malaria and pneumonia with Plasmodium falciparum parasitemia were randomized to receive TS or SP plus E. Clinical and parasitologic responses and gametocytemia prevalence were obtained. A total of 87.2% of children receiving TS and 80.0% receiving SP plus E reached adequate clinical and parasitologic responses (ACPRs) (P = 0.19). Severely malnourished children were less likely to achieve ACPRs than those better nourished (relative risk = 3.34, P = 0.03). Day 7 gametocyte prevalence was 55% and 64% among children receiving TS and SP plus E, respectively (P = 0.19). Thus, TS and SP plus E remain efficacious treatment of P. falciparum malaria in this setting. However, patient adherence and effectiveness of five days of treatment with TS is unknown.

Received September 10, 2004. Accepted for publication April 13, 2005.

Acknowledgments: We thank the study staff and the Chilomoni Health Center staff for their hard work and dedication to completing this study. We also thank the study participants, parents, and community of Chilomoni.

Financial support: This study was supported by the African Integrated Malaria Initiative (7921-3079) of the United States Agency for International Development.

^* Address correspondence to Mary J. Hamel, Malaria Branch, Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Unit 64112, APO, AE, 09831. E-mail: mhamel{at}ke.cdc.gov

Authors’ addresses: Mary J. Hamel, Malaria Branch, Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, APO AE 09831, Telephone: 254-57-20-22902, Fax: 254-57-20-22981, E-mail: mhamel{at}ke.cdc.gov. Timothy Holtz, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, Telephone: 404-639-3311, Fax: 770-488-7761, E-mail: tholtz{at}cdc.gov. Christopher Mkandala and Nyokase Kaimila, Blantyre District Health Office, Private Bag 66, Blantyre, Malawi, Telephone and Fax: 265-1-676-071, E-mails: cmkandala{at}yahoo.com and nkaimila{at}cdcmalaria.org. Nyson Chizani, Centers for Disease Control and Prevention-Malawi Malaria Program, Private Bag 240, Blantyre, Malawi, Telephone: 265-1-676-071, Fax: 265-1-677-371, E-mail: nchisani{at}cdcmalaria.org. Peter Bloland, Malaria Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, Telephone: 770-488-7755, Fax: 770-488-7761, E-mail: pbloland{at}cdc.gov. James Kublin, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, PO Box 19024, Seattle, WA 98109, Telephone: 206-667-1970, Fax: 206-667-4411, E-mail: jkublin{at}fhcrc.org. Peter Kazembe, Malawi Ministry of Health, Lilongwe, Malawi, Telephone: 265-8-822-447, E-mail: pnkazembe{at}malawi.net. Richard Steketee, Program for Appropriate Technology in Health, 1455 NW Leary Way, Seattle, WA 98107, Telephone: 206-285-3500, Fax: 206-285-6619, E-mail: ris1{at}cdc.gov.

Reprint requests: Mary J. Hamel, Malaria Branch, Centers for Disease Control and Prevention/Kenya Medical Research Institute Research Station, Unit 64112, APO, AE, 09831.

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