A randomized comparative study of chloroquine, amodiaquine and sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Ghana

Abstract

SummaryThe study examined the efficacy of chloroquine (CQ), amodiaquine (AQ) and sulphadoxinepyrimethamine (SP) for the treatment of uncomplicated Plasmodium falciparum malaria in Ghana.A total of 351 children were randomized to receive either of the three study drugs. Patients were evaluated using the WHO 14-day in vivo antimalarial testing guidelines. The 14-day adequate clinical and parasitological response analysis revealed that CQ, 46.7% (95% CI 37.5, 56.0) has the least efficacy compared with AQ, 86.1% (95% CI 78.3, 91.8) and SP, 77.6% (95% CI 68.9, 84.8). Late parasite failures were also lower and similar in the AQ and SP (9.6% and 10.3%) than in the CQ (32.5%) group. However, CQ and AQ groups showed better fever clearance compared with SP throughout except for day 7 and after when possibly due to its significant late clinical failures, clearance by CQ was lower. Our findings suggest that CQ is no longer useful in Ghana and should be replaced as a first-line treatment of malaria. Replacement of CQ preferably with AQ combination treatment will be an effective and an affordable alternative for the treatment of uncomplicated malaria.

Prevalence of In Vitro Resistance to Eleven Standard or New Antimalarial Drugs among Plasmodium falciparum Isolates from Pointe-Noire, Republic of the Congo

“…Only 2% of the isolates are resistant to the active metabolite of amodiaquine, monodesethylamodiaquine, confirming previous observations that amodiaquine might still be effective where chloroquine resistance is high (9,23,28). These data are consistent with previous in vitro observations in the Republic of the Congo (7).…”

A Randomized, Controlled Trial of Intermittent Preventive Treatment with Sulfadoxine‐Pyrimethamine, Amodiaquine, or the Combination in Pregnant Women in Ghana

“…The drug susceptibility study results must be interpreted with caution because of the small sample size. However, these findings are compatible with results obtained for children in the area [13]. Drug efficacy is likely to be higher in asymptomatic pregnant women than in symptomatic children [35,36].…”

“…The average entomologic inoculation rate is 418 infective bites per person per year [23]. In 2004, the uncorrected parasitological failure rates at day 28 after treatment with SP or AQ in children Ͻ5 years of age were 10.3% and 9.6%, respectively [13]. The prevalence of HIV infection among antenatal attendants was 2.8% in 2004 [24].…”

“…The efficacy of the drugs in clearing peripheral parasitemia by day 28 after a first course of IPTp among women who had parasitemia at enrollment was assessed using a modified WHO protocol [26]. The sample size for this substudy was calculated to detect a parasite clearance rate of 80% by day 28, at 95% significance and 80% power, under the assumption that the parasitological response would be no less than 78% for SP and 86% for AQ or SPAQ, as observed in children Ͻ5 years of age in the area [13]. Allowing for a 15% loss to follow-up on day 28, a total of 615 women were needed for the study.…”

“…However, information available on the safety of most antimalarial drugs is insufficient to warrant their regular use in pregnant women [11]. Amodiaquine (AQ) is an effective antimalarial [12][13][14]. It has been safe and effective when used for IPT in infants [15] and for treatment of uncomplicated malaria in pregnant women [16].…”