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 ofAQ+ 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.