Sarah G. Staedke

Makerere University

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Grant Dorsey

University of California, San Francisco

Philip J. Rosenthal

University of California, San Francisco

Moses R. Kamya

Makerere University

Ambrose Talisuna

World Health Organization Regional Office for Africa

Bryan Greenhouse

University of California, San Francisco

Emmanuel Arinaitwe

Infectious Diseases Research Collaboration

Adoke Yeka

Makerere University

Steve W. Lindsay

Durham University

Hasifa Bukirwa

African Field Epidemiology Network

Bridget Nzarubara

Infectious Diseases Research Collaboration

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Makerere University

University of Oxford

London School of Hygiene & Tropical Medicine

University of California, San Francisco

Infectious Diseases Research Collaboration

University of London

San Francisco General Hospital

Mahidol Oxford Tropical Medicine Research Unit

Kenya Medical Research Institute

Mahidol University

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Additional file 4: of Why is malaria associated with poverty? Findings from a cohort study in rural Uganda

Figshare (2016)

Lucy S. Tusting John Rek Emmanuel Arinaitwe Sarah G. Staedke Moses R. Kamya

Data files. (ZIP 15Â kb)

10.6084/m9.figshare.c.3641432_d2

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Citations (0)

Prevention of Increasing Rates of Treatment Failure by Combining Sulfadoxine‐Pyrimethamine with Artesunate or Amodiaquine for the Sequential Treatment of Malaria

The Journal of Infectious Diseases (2003)

Grant Dorsey Jonathan Vlahos Moses R. Kamya Sarah G. Staedke Philip J. Rosenthal

Combination antimalarial therapy may delay the spread of drug resistance, but clinical data supporting this notion are limited. For 1 year, we studied Ugandan children who were treated for uncomplicated malaria with sulfadoxine-pyrimethamine (SP), SP + amodiaquine (AQ), or SP + artesunate (AS). We compared treatment responses and the prevalence of resistance-conferring mutations of new infections with those of recrudescent infections due to parasites that survived prior treatment. Recrudescent infections were associated with the selection of SP resistance-conferring mutations in all treatment groups, but responses to repeat therapy differed. Compared with initial treatments, treatment of recrudescent infections was associated with a higher rate of treatment failure (hazard ratio [HR], 2.44; P=.01), for the SP group, but with a lower rate of treatment failure (HR, 0.40; P=.08), for the SP + AS group. Treatment failure in the SP + AQ group was uncommon, limiting the analysis of recrudescent parasites. Our results suggest that the use of combination antimalarial therapy in Africa may slow the spread of drug-resistant malaria and prolong the therapeutic life span of available treatment regimens.

Amodiaquine

Artesunate

Sulfadoxine/pyrimethamine

Sulfadoxine

Combination therapy

10.1086/378523

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Citations (40)

Questions about the antimalarial amodiaquine

The Lancet (2003)

Sarah G. Staedke Grant Dorsey Philip J. Rosenthal

Amodiaquine

10.1016/s0140-6736(03)12944-3

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Citations (2)

Combination treatments for uncomplicated falciparum malaria in Kampala, Uganda: randomised clinical trial

The Lancet (2004)

Sarah G. Staedke Arthur Mpimbaza Moses R. Kamya Bridget Nzarubara Grant Dorsey

10.1016/s0140-6736(04)17478-3

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Citations (107)

DEPARTMENT OF ERROR

The Lancet (2003)

Sarah G. Staedke Grant Dorsey Philip J. Rosenthal

10.1016/s0140-6736(03)12947-9

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Increasing antimalarial drug resistance in Uganda and revision of the national drug policy

Tropical Medicine & International Health (2002)

Moses R. Kamya Nathan Bakyaita Ambrose Talisuna Wilson Were Sarah G. Staedke

Summary Chloroquine (CQ) resistance was first documented in Uganda in 1988. Subsequent surveillance of antimalarial drug resistance, conducted by the Ugandan Ministry of Health and several research organizations, suggests that resistance to CQ is now widespread, reaching critical levels in many areas of the country. In June 2000, the Ministry of Health held a National Consensus Meeting to evaluate the available drug efficacy data and review the national antimalarial drug policy. After extensive debate, the combination of CQ + sulfadoxine–pyrimethamine (SP) was chosen to replace CQ as the first‐line treatment of uncomplicated malaria as an interim policy. This review evaluates the in vivo drug efficacy studies conducted in Uganda since 1988 and issues confronted in revision of the drug policy. The Ugandan experience illustrates the challenges faced by sub‐Saharan African countries confronted with rising CQ resistance but limited data on potential alternative options. The choice of CQ + SP as a provisional policy in the absence of prerequisite efficacy, safety and cost‐effectiveness data reflects the urgency of the malaria treatment problem, and growing pressure to adopt combination therapies. Surveillance of CQ + SP treatment efficacy, collection of additional data on alternative regimens and active consensus building among key partners in the malaria community will be necessary to develop a rational long‐term antimalarial treatment policy in Uganda.

Interim

Christian ministry

10.1046/j.1365-3156.2002.00974.x

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Citations (77)

Artemisinin-Based Combination Treatment for Malaria in Africa: No Perfect Solutions

Clinical Infectious Diseases (2005)

C. W. M. Whitty Sarah G. Staedke

Drug-resistant malaria is one of the major public health challenges facing Africa. The spread of resistance to chloroquine and subsequently sulfadoxine pyrimethamine (SP) means that the era of inexpensive monotherapy for malaria is passing or has passed. There is widespread acceptance that a combination of = 2 antimalarial drugs should now become standard treatment policy as it is for tuberculosis and HIV infection. There has been a strong push which has sometimes run ahead of the evidence to encourage countries in Africa to adopt artemisinin-based combination treatment (ACT) as first-line treatment for uncomplicated malaria as soon as possible. The decision that drug combinations should be used in principle is one thing; the decision about which combinations to use and how they are best deployed is quite another. A number of practical questions remain unanswered for countries looking to implement ACT including questions about the effectiveness safety availability and importantly cost of new drugs. The cost of ACTs is ~10 times that of current monotherapy and it is currently unclear how ACTs can be used on a wide scale in Africa without substantial and sustained subsidization. (excerpt)

Sulfadoxine

Combination therapy

10.1086/444464

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Citations (16)

A pooled analysis of the duration of chemoprophylaxis against malaria after treatment with artesunate-amodiaquine and artemether-lumefantrine: data & analysis output

Zenodo (CERN European Organization for Nuclear Research) (2019)

Michael T. Bretscher Prabin Dahal Jamie T. Griffin Kasia Stepniewska Quique Bassat

Data files and analysis output associated with the medRxiv preprint article: Bretscher et al. 2019 A pooled analysis of the duration of chemoprophylaxis against malaria after treatment with artesunate-amodiaquine and artemether-lumefantrine.

Amodiaquine

Lumefantrine

Artemether

Artesunate

Artemether/lumefantrine

Chemoprophylaxis

10.5281/zenodo.3339215

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Pharmacovigilance of antimalarial treatment in Africa: is it possible?

Malaria Journal (2006)

Ambrose Talisuna Sarah G. Staedke Umberto D’Alessandro

Pharmacovigilance, defined as "the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other possible drug related problem", is increasingly being recognized in Africa. Many African countries have simultaneously adopted artemisinin derivative based combination therapy (ACT) as first-line treatment for uncomplicated malaria, offering an opportunity to assess the safety of these drugs when used widely. While ACTs appear to be safe and well-tolerated, there is little experience with these medicines in Africa, outside clinical trials. Pharmacovigilance for ACTs and other combination treatments in Africa is essential. Malaria transmission intensity is high and antimalarial medicines are used frequently. Presumptive treatment of fever with antimalarials is common, often in the absence of a confirmed diagnosis, using drugs obtained without a prescription. Informal use of antimalarial drugs may increase the risk of incorrect dosing, inappropriate treatment, and drug interactions, which may impact negatively on drug safety. Furthermore, the administration of antimalarial treatments in patients with a concomitant illness, including HIV/AIDs, tuberculosis and malnutrition, is a concern. African countries are being encouraged to establish pharmacovigilance systems as ACTs are rolled out. However, pharmacovigilance is difficult, even in countries with a well-developed health care system. The rationale for pharmacovigilance of antimalarial drugs is discussed here, outlining the practical challenges and proposing approaches that could be adopted in Africa.

10.1186/1475-2875-5-50

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Citations (74)

Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate for treatment of uncomplicated malaria: a longitudinal randomised trial

The Lancet (2002)

Grant Dorsey Denise Njama Moses R. Kamya Adithya Cattamanchi Daniel Kyabayinze

Amodiaquine

Artesunate

Sulfadoxine/pyrimethamine

Sulfadoxine

10.1016/s0140-6736(02)12021-6

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Citations (139)