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Azithromycin plus artesunate may not be suitable for malaria treatment in areas of high drug resistance Africa
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Asexual parasites may have developed in almost 40% more children who were treated for malaria with azithromycin plus artesunate than in children who were treated with artemether-lumefantrine, according to results of a recent study.
The trial involved children aged 6 to 59 months who had uncomplicated malaria. The trial location was Muheza, Tanzania, which is an area with high levels of existing antimalarial drug resistance.
Researchers randomly assigned 129 children to receive azithromycin plus artesunate and 132 children to receive artemether-lumefantrine (Coartem, Novartis). Outcome measures included parasitological failure by days 28 and 42 and failure corrected for reinfection.
When 200 patients reached the 28-day follow-up point, planned interim analysis was conducted.
All children had a complete response to treatment initially. However, at or by day 28, 58% of children (69 of 119) in the azithromycin plus artesunate arm had asexual parasites, compared with 20% of children (24 of 120) in the artemether-lumefantrine arm (adjusted OR for failure with azithromycin plus artesunate treatment, 6.1; 95% CI, 3.3-11.4).
Further analysis was conducted only in children with recrudescence. In that population, the parasitological failure rate was 32% in the azithromycin plus artesunate arm and 9% in the artemether-lumefantrine arm.
Day 42 results demonstrated that these differences between the two treatment groups were maintained.
Sykes A et al. Clin Infect Dis. 2009;49:1195-1201.