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Gametocytaemia after drug treatment of asymptomatic Plasmodium falciparum.

Dunyo S, Milligan P, Edwards T, Sutherland C, Targett G, Pinder M - PLoS Clin Trials (2006)

Bottom Line: Gametocyte carriage (the area under the curve of gametocyte density versus time), was reduced by 71% in the SP group, and by 74% in the SP+AS group, compared to placebo.Gametocyte carriage varied with age and was greater among children under 15 than among adults.Effective treatment of asexual parasitaemia in the dry season reduces gametocyte carriage to very low levels after 4 wk.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council Laboratories, Banjul, Gambia.

ABSTRACT

Objectives: Treatment of Plasmodium falciparum malaria with sulfadoxine-pyrimethamine (SP) is followed by a sharp rise in the prevalence and density of gametocytes. We did a randomized trial to determine the effect of treatment of asymptomatic infections with SP or SP plus one dose of artesunate (SP+AS) on gametocyte carriage.

Design: The study was a three-arm open-label randomized trial. We randomized asymptomatic carriers of P. falciparum to receive antimalarial treatment or placebo, and recorded the prevalence and density of gametocytes over the next 2 mo.

Setting: The trial was conducted during the dry (low malaria transmission) season in four rural villages in Gambia.

Participants: Participants were adults and children aged over 6 mo with asexual P. falciparum infection and confirmed free of clinical symptoms of malaria over a 2-d screening period.

Interventions: Participants were randomized to receive a single dose of SP or SP+AS or placebo.

Outcome measures: The outcome measures were the presence of gametocytes 7 and 56 d after treatment, and the duration and density of gametocytaemia over 2 mo.

Results: In total, 372 asymptomatic carriers were randomized. Gametocyte prevalence on day 7 was 10.5% in the placebo group, 11.2% in the SP group (risk difference to placebo 0.7%, 95% confidence interval -7.4% to 8.7%, p = 0.87), and 7.1% in the SP+AS group (risk difference to placebo 4.1%, 95% confidence interval -3.3% to 12%, p = 0.28). By day 56, gametocyte prevalence was 13% in the placebo group and 2% in both drug-treated groups. Gametocyte carriage (the area under the curve of gametocyte density versus time), was reduced by 71% in the SP group, and by 74% in the SP+AS group, compared to placebo. Gametocyte carriage varied with age and was greater among children under 15 than among adults.

Conclusions: Treatment of asymptomatic carriers of P. falciparum with SP does not increase gametocyte carriage or density. Effective treatment of asexual parasitaemia in the dry season reduces gametocyte carriage to very low levels after 4 wk.

No MeSH data available.


Related in: MedlinePlus

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pctr-0010020-g002: Trial Profile

Mentions: Out of 1,148 screened individuals, 372 had asymptomatic P. falciparum infection above 20 parasites per microlitre and were enrolled into the trial (Figure 2). In addition, 39 clinical cases that were not randomized were treated with SP+AS and followed up. The randomized groups were similar in demographic and clinical characteristics and asexual parasite density and gametocyte rates at baseline (Table 2). On completion of follow-up (D56), parasitological data were available for 339 (91%) individuals in the trial. During the 56 d of follow-up there were no cases of clinical malaria and no adverse events were reported in any trial participants.


Gametocytaemia after drug treatment of asymptomatic Plasmodium falciparum.

Dunyo S, Milligan P, Edwards T, Sutherland C, Targett G, Pinder M - PLoS Clin Trials (2006)

Trial Profile
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1851719&req=5

pctr-0010020-g002: Trial Profile
Mentions: Out of 1,148 screened individuals, 372 had asymptomatic P. falciparum infection above 20 parasites per microlitre and were enrolled into the trial (Figure 2). In addition, 39 clinical cases that were not randomized were treated with SP+AS and followed up. The randomized groups were similar in demographic and clinical characteristics and asexual parasite density and gametocyte rates at baseline (Table 2). On completion of follow-up (D56), parasitological data were available for 339 (91%) individuals in the trial. During the 56 d of follow-up there were no cases of clinical malaria and no adverse events were reported in any trial participants.

Bottom Line: Gametocyte carriage (the area under the curve of gametocyte density versus time), was reduced by 71% in the SP group, and by 74% in the SP+AS group, compared to placebo.Gametocyte carriage varied with age and was greater among children under 15 than among adults.Effective treatment of asexual parasitaemia in the dry season reduces gametocyte carriage to very low levels after 4 wk.

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council Laboratories, Banjul, Gambia.

ABSTRACT

Objectives: Treatment of Plasmodium falciparum malaria with sulfadoxine-pyrimethamine (SP) is followed by a sharp rise in the prevalence and density of gametocytes. We did a randomized trial to determine the effect of treatment of asymptomatic infections with SP or SP plus one dose of artesunate (SP+AS) on gametocyte carriage.

Design: The study was a three-arm open-label randomized trial. We randomized asymptomatic carriers of P. falciparum to receive antimalarial treatment or placebo, and recorded the prevalence and density of gametocytes over the next 2 mo.

Setting: The trial was conducted during the dry (low malaria transmission) season in four rural villages in Gambia.

Participants: Participants were adults and children aged over 6 mo with asexual P. falciparum infection and confirmed free of clinical symptoms of malaria over a 2-d screening period.

Interventions: Participants were randomized to receive a single dose of SP or SP+AS or placebo.

Outcome measures: The outcome measures were the presence of gametocytes 7 and 56 d after treatment, and the duration and density of gametocytaemia over 2 mo.

Results: In total, 372 asymptomatic carriers were randomized. Gametocyte prevalence on day 7 was 10.5% in the placebo group, 11.2% in the SP group (risk difference to placebo 0.7%, 95% confidence interval -7.4% to 8.7%, p = 0.87), and 7.1% in the SP+AS group (risk difference to placebo 4.1%, 95% confidence interval -3.3% to 12%, p = 0.28). By day 56, gametocyte prevalence was 13% in the placebo group and 2% in both drug-treated groups. Gametocyte carriage (the area under the curve of gametocyte density versus time), was reduced by 71% in the SP group, and by 74% in the SP+AS group, compared to placebo. Gametocyte carriage varied with age and was greater among children under 15 than among adults.

Conclusions: Treatment of asymptomatic carriers of P. falciparum with SP does not increase gametocyte carriage or density. Effective treatment of asexual parasitaemia in the dry season reduces gametocyte carriage to very low levels after 4 wk.

No MeSH data available.


Related in: MedlinePlus