Abstract
BackgroundCombination therapy has become a new paradigm in malaria treatment. Amodiaquine is a common partner drug in different malaria combination therapies used or investigated in sub-Saharan Africa, but data on its efficacy as a single drug are scarce.MethodsThe objective of the study was to determine the efficacy of amodiaquine against falciparum malaria in neighbouring rural and urban areas of north-western Burkina Faso. The study was designed as an uncontrolled trial in children aged 6–59 months with uncomplicated falciparum malaria in the Nouna Health District.ResultsDuring the rainy season 2005, 117 children were enrolled, 62 from the rural and 55 from the urban study area. The crude adequate clinical and parasitological response (ACPR) rate was 103/117 (88%) by day 14 but decreased to 28/117 (24%) by day 28. After PCR correction for reinfections, ACPR rates were 108/117 (92%) and 71/117 (61%) by day 14 and day 28, respectively. There were no significant differences in efficacy between urban and rural areas. The Plasmodium falciparum crt K76T mutation not predict AQ failure, but was selected in parasites re-appearing following treatment. No serious adverse events occurred and only 16 other adverse events were recorded.ConclusionCompared to chloroquine, amodiaquine is more effective against uncomplicated falciparum malaria in Burkina Faso. However, a considerable degree of amodiaquine resistance already exists and it is currently unclear how this resistance will develop when amodiaquine in combination with other drugs is used on a large scale.Trial registrationCurrent Controlled Trials ISRCTN73824458.
Highlights
Combination therapy has become a new paradigm in malaria treatment
In sub-Saharan African (SSA), the basis of malaria control remains early diagnosis and prompt treatment with effective drugs [1]. This strategy is complicated by increasing resistance of Plasmodium falciparum to existing and affordable first-line drugs such as chloroquine (CQ) or sulphadoxine/pyrimethamine (SP) in most SSA countries [1,2,3]
Artemisinin-based combination treatment (ACT) involving a variety of partner drugs has proved highly effective in a number of field trials [10,11,12,13,14,15,16,17,18,19,20,21]
Summary
Amodiaquine is a common partner drug in different malaria combination therapies used or investigated in sub-Saharan Africa, but data on its efficacy as a single drug are scarce. In sub-Saharan African (SSA), the basis of malaria control remains early diagnosis and prompt treatment with effective drugs [1]. This strategy is complicated by increasing resistance of Plasmodium falciparum to existing and affordable first-line drugs such as chloroquine (CQ) or sulphadoxine/pyrimethamine (SP) in most SSA countries [1,2,3]. Combination treatment has become a new paradigm in malaria control, with the particular aim to delay and possibly reverse the development of drug resistance [4,5,6,7,8,9]. More recent data indicate that CQ in north-western Burkina Faso has gradually lost efficacy and suffers treatment failure rates of partly more than 50% by day 14, with marked differences between rural and urban areas [30,31,32]
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