A comparison of amodiaquine and sulfadoxine-pyrimethamine as first-line treatment of falciparum malaria in Kenya

A randomized 14-day study in vivo compared the: response of Plasmodium falc iparum malaria to amodiaquine (35 mg/kg) and sulfadoxine-pyrimethamine (sul fadoxine, 25 mg/kg) in symptomatic outpatients at 2 sites in northern and w estern Kenya during 1993. Of the 239 patients recruited, 181 (76%) complete d the study [84 (46%) on amodiaquine and 97 (54%) on sulfadoxine-pyrimetham ine]. There were no significant differences in the parasitological, clinica l or haematological responses between the 2 drug groups in both areas, with 18.5% resistance to amodiaquine versus 9.5% for sulfadoxine-pyrimethamine in the north and 35.1% against amodiaquine versus 34.5% for sulfadoxine-pyr imethamine in the west. In both sites defervescence was significantly more rapid with amodiaquine (P < 0.05) and true clinical failure (symptomatic il lness with recurrent parasitaemia) was unusual (9%). As high-level resistan ce to chloroquine is widespread, both drugs are valuable alternatives. Howe ver, the significantly higher levels of resistance in the west may be a sig n of the: increased drug pressure in this holoendemic area and send an impo rtant warning concerning resistance to sulfadoxine-pyrimethamine.