ATOVAQUONE AND PROGUANIL FOR PLASMODIUM-FALCIPARUM MALARIA

Background The increasing spread of multidrug-resistant Plasmodium fal ciparum malaria emphasises the urgent need for alternative treatment r egimens. The objective of the study was to establish the efficacy of a novel drug combination. We compared a combination of atovaquone and p roguanil with amodiaquine in the treatment of acute uncomplicated P fa lciparum malaria in Lambarene Gabon. Methods 142 adults were randomly allocated either a combination treatment of atovaquone 1000 mg daily a nd proguanil 400 mg daily for 3 days or treatment with amodiaquine 600 mg on admission, 600 mg 24 h later, and 300 mg after a further 24 h. Symptoms and clinical signs were recorded and giemsa-stained thick blo od smears were done every 12 h until patients had been symptom-free an d aparasitaemic for 24 h. 126 patients were followed up for 28 days or until recrudescence. Findings In the atovaquone plus proguanil group 62 (87%) of 71 patients were cured and only one had recrudescent infec tion, By contrast, the cure rate was significantly lower (p=0 . 022) w ith amodiaquine (51 [72%] of 71; there were 12 recrudescences in the a modiaquine group), Eight patients in each group were lost to follow-up . Patients treated with atovaquone plus proguanil complained of nausea (33%) and vomiting (29%), and the most commonly reported adverse effe cts of amodiaquine were pruritus (43%) and insomnia (27%). Interpretat ion Atovaquone and proguanil was a highly effective and safe drug comb ination in patients with acute uncomplicated P falciparum malaria in G abon.