A randomised clinical trial of combination artesunate and azithromycin for treatment of uncomplicated Plasmodium falciparum malaria in Thailand.

Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
The Southeast Asian journal of tropical medicine and public health (Impact Factor: 0.72). 01/2001; 31(4):801-7.
Source: PubMed


Recently, a combination of artesunate and mefloquine has proved effective, although is contraindicated in early pregnancy and young children. Azithromycin, a widely used antibiotic and has antimalarial effects, replace mefloquine as a new alternative antimalarial regimen. Two hundred and two uncomplicated falciparum malaria patients were randomly assigned to 1 of 3 regimens. Patients in group I (n = 68) received artesunate 200 mg once daily for 3 days, group II (n = 67) received artesunate 200 mg together with mefloquine 10 mg/kg on the first 2 days and artesunate 200 mg together with mefloquine 5 mg/kg on the third day, and group III (n = 67) received artesunate 200 mg together with azithromycin 50 mg once daily for 3 days. The 28 day cure rates were 44, 98 and 56%, respectively. The median time to recrudescence was significantly longer in group III. In conclusion, a combination of artesunate and azithromycin might be useful in treating children in whom bacterial and malarial infections may be concomitant. However, further work is required in order to enhance its clinical efficacy.

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    • "Azithromycin, for example, has demonstrated efficacy against chlamydia, gonorrhoea, chancroid, incubating syphilis, mycoplasma, and possibly bacterial vaginosis, and appears to be without teratogenic risk [38-44]. Azithromycin has been used for mass treatment of other infections, and has demonstrated efficacy against P falciparum and P vivax [45-47]. Three trials conducted since the Cochrane review have provided further evidence, at least for perinatal outcomes, of the benefits of prophylactic antibiotics in pregnancy [48]. "
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    • "Azithromycin is not yet licensed for use as an antimalarial agent but has shown promising activity against P. falciparum in vitro[74,75], in the murine malaria model[76] and in randomized controlled clinical trials [77-79]. A phase III randomized placebo-controlled clinical trial of azithromycin prophylaxis (750 mg loading dose followed by 250 mg/day for 20 weeks) versus doxycycline (100 mg/day for 20 weeks) conducted among 300 non-pregnant Indonesian adults (286/300 male) found that azithromycin was safe and well tolerated when used alone for the prevention of falciparum malaria in Northeast Papua[77]. "
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