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- W2024768242 abstract "Grant Dorsey and co-workers (Dec 21/28, p 2031)1Dorsey G Njama D Kamya MR et al.Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate for treatment of uncomplicated malaria: a longitudinal randomised trial.Lancet. 2002; 360: 2031-2038Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar recommend sulfadoxine/pyrimethamine with amo-diaquine for treatment of malaria in Uganda. This regimen was more successful than sulfadoxine/ pyrimethamine alone or in combination with artesunate.The chequered history of amodiaquine warrants some comment. This antimalarial was briefly recommended for prophylaxis in travellers during the 1980s, but was subsequently abandoned after reports that it can induce immune-mediated granulocytopenia in one of 2000 patients.2Hatton CS Peto TE Bunch C et al.Frequency of severe neutropenia associated with amodiaquine prophylaxis against malaria.Lancet. 1986; 1: 411-414Summary PubMed Scopus (197) Google Scholar By matter of comparison, this is roughly 20 times the incidence of aplastic anaemia caused by chloramphenicol.I was, therefore, surprised to find that Dorsey and colleagues make no mention of leucocyte counts. Their study design seems to preclude discovery of granulocytopenia, if, indeed, it did occur. Can one be sure that the one death reported was caused by malaria, and not by sepsis secondary to granulocytopenia?There are, of course, other treatment options for malaria, such as mefloquine. How do you weigh the high cost of mefloquine against the risk of severe granulocytopenia associated with amodiaquine? Grant Dorsey and co-workers (Dec 21/28, p 2031)1Dorsey G Njama D Kamya MR et al.Sulfadoxine/pyrimethamine alone or with amodiaquine or artesunate for treatment of uncomplicated malaria: a longitudinal randomised trial.Lancet. 2002; 360: 2031-2038Summary Full Text Full Text PDF PubMed Scopus (122) Google Scholar recommend sulfadoxine/pyrimethamine with amo-diaquine for treatment of malaria in Uganda. This regimen was more successful than sulfadoxine/ pyrimethamine alone or in combination with artesunate. The chequered history of amodiaquine warrants some comment. This antimalarial was briefly recommended for prophylaxis in travellers during the 1980s, but was subsequently abandoned after reports that it can induce immune-mediated granulocytopenia in one of 2000 patients.2Hatton CS Peto TE Bunch C et al.Frequency of severe neutropenia associated with amodiaquine prophylaxis against malaria.Lancet. 1986; 1: 411-414Summary PubMed Scopus (197) Google Scholar By matter of comparison, this is roughly 20 times the incidence of aplastic anaemia caused by chloramphenicol. I was, therefore, surprised to find that Dorsey and colleagues make no mention of leucocyte counts. Their study design seems to preclude discovery of granulocytopenia, if, indeed, it did occur. Can one be sure that the one death reported was caused by malaria, and not by sepsis secondary to granulocytopenia? There are, of course, other treatment options for malaria, such as mefloquine. How do you weigh the high cost of mefloquine against the risk of severe granulocytopenia associated with amodiaquine? Questions about the antimalarial amodiaquineAuthors' reply Full-Text PDF" @default.
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- W2024768242 date "2003-04-01" @default.
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- W2024768242 title "Questions about the antimalarial amodiaquine" @default.
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- W2024768242 doi "https://doi.org/10.1016/s0140-6736(03)12943-1" @default.
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