Drug-resistant P. falciparum malaria is a serious problem in sub-Saharan Africa. Chloroquine resistance is a major contributor to the increase in malaria-related illness and death among African children, and resistance to sulfadoxine/pyrimethamine (an inexpensive, widely used alternative) is emerging. Bob Taylor from WHO, Geneva, Switzerland, and collaborating colleagues assessed the safety and treatment efficacy of adding artesunate to amodiaquine in three randomised trials in Kenya, Sngal, and Gabon.
941 children (400 in Kenya, 321 in Sngal, and 220 in Gabon) who were younger than 11 years and who had uncomplicated P. falciparum malaria took part in the study. They were randomly assigned amodiaquine (10 mg/kg per day for 3 days) plus artesunate (4 mg/kg per day for 3 days) or amodiaquine and placebo (for 3 days).
The cure rates after two weeks treatment for amodiaquine-artesunate compared with amodiaquine were: 91% versus 74% in Kenya, 93% versus 94% in Sngal, and 98% versus 90% in Gabon. Corresponding cure rates after one month were 68% versus 41% in Kenya, 82% versus 79% in Sngal, and 85% versus 71% in Gabon
Bob Taylor comments: For African countries that are considering a change of their current first-line antimalarial drug, amodiaquine-artesunate is an option. Cost, access, and local efficacy data are also fundamental elements to consider before amodiaquine-artesunate or other drug combinations are implemented as policy. Longitudinal studies should now address the general question of how best to deploy artemisinin-based combinations, and the safety of amodiaquine-artesunate and its potential effect on the development of drug resistance and transmission.