Improved efficacy with amodiaquine instead of chloroquine in sulfadoxine/pyrimethamine combination treatment of falciparum malaria in Uganda: experience with fixed-dose formulation.

Abstract

Amodiaquine (AQ) is an affordable compound, chemically related to chloroquine (CQ) but often effective against CQ resistant Plasmodium falciparum. In Uganda, a pre-packed fixed-dose combination of CQ plus sulfadoxine/pyrimethamine (CQ+SP) called Homapak is used in the home based management of fever program (HBM). We performed a single blind randomized trial to determine the efficacy of AQ+SP in comparison with the fixed-dose CQ+SP (Homapak) in the treatment of uncomplicated falciparum malaria in Ugandan children aged 6 months to 5 years. The study was done in 2004 at Walkuba Health Center, a sub-urban area in Jinja district, Uganda. Primary outcome was the day 14 per protocol clinical and parasitological response according to the WHO. A total of 183 children were included (mean age 28 months) and 90% completed 28 days of follow up. The day 14 adequate clinical and parasitological response was 70.9% for CQ+SP and 97.4% for AQ+SP (p<0.001). In those given CQ+SP, treatment failure rates for the 6 months to 2 years age group were much higher (48.2%) than in the older children (18.2%, p=0.004). The day 28 PCR adjusted parasitological failure rates were also higher in the CQ+SP (31.3%) than in the AQ+SP group (13.1%) (p=0.003), with a higher gametocyte carriage among the CQ+SP group. We conclude that the efficacy of AQ+SP was significantly superior to the fixed-dose CQ+SP (Homapak), particularly among the youngest children. Thus, AQ could be used instead of CQ in combination with SP to improve the effectiveness against falciparum malaria in Uganda.

• Authors: C Obua, L L Gustafsson, C Aguttu, W W Anokbonggo, J W Ogwal-Okeng, J Chiria, U Hellgren
• Journal: Acta tropica (Acta Trop) Vol. 100 Issue 1-2 Pg. 142-50 (Nov 2006) ISSN: 0001-706X [Print] Netherlands
• PMID: 17113554 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Drug Combinations
• Amodiaquine
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Chloroquine
• Pyrimethamine

Topics

• Amodiaquine (administration & dosage, therapeutic use)
• Animals
• Antimalarials (administration & dosage, therapeutic use)
• Child, Preschool
• Chloroquine (administration & dosage, therapeutic use)
• Drug Administration Schedule
• Drug Combinations
• Drug Therapy, Combination
• Humans
• Infant
• Malaria, Falciparum (drug therapy, parasitology)
• Plasmodium falciparum (drug effects)
• Pyrimethamine (administration & dosage, therapeutic use)
• Sulfadoxine (administration & dosage, therapeutic use)
• Treatment Outcome
• Uganda