ABSTRACT
Bangladesh faces growing levels of Plasmodium falciparum resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP). Alternative antimalarial therapies, particularly combination regimens, need to be considered. Therefore, the efficacy of three antimalarial combination therapies was assessed in Chittagong Hill Tracts. A total of 364 P. falciparum patients were recruited and randomly assigned to either CQ + SP, mefloquine + artesunate (MQ + AS) or lumefantrine + artemether (Coartem). Results showed that CQ + SP therapy was less effective than the two artemisinin-based combination therapies. The day 42 PCR-corrected efficacy rate was 62.4% for CQ + SP, 100% for MQ + AS and 97.1% for Coartem. Failures occurred at a shorter interval after CQ + SP treatment than after Coartem. The artemisinin-based therapies effectively prevented development of gametocytes, whereas CQ + SP did not. All three therapies were well tolerated, although reports of mild complaints during treatment appeared higher with MQ + AS. We conclude that CQ + SP is not a viable option for replacing CQ monotherapy as first-line P. falciparum treatment in this area of Bangladesh. A change to artemisinin-based combination therapy is recommended. Both Coartem and MQ + AS appear to be good options, effective in curing P. falciparum malaria and in preventing recrudescences following treatment.
Subject(s)
Antimalarials/administration & dosage , Malaria, Falciparum/drug therapy , Adolescent , Artemether , Artemisinins/administration & dosage , Artesunate , Bangladesh/epidemiology , Child , Child, Preschool , Chloroquine/administration & dosage , Drug Combinations , Drug Therapy, Combination , Ethanolamines/administration & dosage , Female , Fluorenes/administration & dosage , Humans , Infant , Lumefantrine , Malaria, Falciparum/epidemiology , Male , Mefloquine/therapeutic use , Pyrimethamine/administration & dosage , Sesquiterpenes/administration & dosage , Sulfadoxine/administration & dosage , Treatment OutcomeABSTRACT
FI spectrophotometric determination of calcium using murexide has been developed. The problem of the color of the dye fading and/or its complex in an alkaline medium in the batch method can be overcome by taking advantage of FIA. A calcium solution is injected into an ethylenediamine-ethylenediamine hydrochloride buffer (1 M, pH 11) which also serves as a masking agent, and is then merged with the aqueous murexide (0.005%, w/v) and continuously monitored. Simple FIA manifolds, including an LED colorimeter detector hooked up to a PC-based data acquisition and evaluation system are described. Optimization of FIA systems has been made. The proposed procedures have been validated by using reference materials and comparing the results with the standard methods, and then applied to ores and drug samples.
