Results of a randomised trial from Uganda in this week's issue of THE LANCET suggest that the drug combination of amodiaquine and sulfadoxine-pyrimethamine might offer the optimal treatment for malaria in terms of efficacy and cost-effectiveness in this region. The study also shows that the drug combination of chloroquine and sulfadoxine-pyrimethamine--the recommended first-line treatment in Uganda--is far less effective than other drug combinations.

Philip Rosenthal (University of California San Francisco) and colleagues co-ordinated a clinical trial among young children (aged 6 months to 10 years) via a hospital in Kampala, Uganda. Around 400 children were randomly allocated one of three combinations: chloroquine+sulfadoxine-pyrimethamine, amodiaquine+sulfadoxine-pyrimethamine, or amodiaquine+artesunate. The latter two combinations were far more effective, with treatment failures below 10% at one month's follow-up; by contrast, the failure rate of chloroquine+sulfadoxine-pyrimethamine was 35%.

Professor Rosenthal comments: "African countries are faced with a challenge. Escalating drug resistance has rendered chloroquine ineffective, but the best replacement for first-line antimalarial therapy has been unclear. Artemisinin-containing combination therapy has been strongly advocated for use in Africa, but limited clinical experience and the high cost of these regimens are important obstacles. In Kampala, amodiaquine+sulfadoxine-pyrimethamine currently offers a readily available, efficacious, and economical alternativeAlthough the lifespan of amodiaquine+sulfadoxine-pyrimethamine might be limited by resistance, this regimen could be appropriate for regions of Africa where resistance to the individual drugs remains low, as an interim policy pending introduction of artemisinin-containing combinations."

Amir Attaran (University of Ottowa, Canada) states in an accompanying commentary (p 1922): "Rather than clinical efficacy trials, more ur
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
25-Nov-2004

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