Amodiaquine remains effective for treating uncomplicated malaria in West and Central Africa

Many countries in Africa are now confronted with the dilemma of shifting dr ug policies for uncomplicated falciparum malaria from chloroquine, which ha s become largely ineffective, to a new first-line drug and amodiaquine is o ne of the possible options. A multicentre, open-label randomized controlled trial of amodiaquine 30 mg/kg vs chloroquine 25 mg/kg over 3 days was perf ormed in Senegal, Cameroon, Gabon, and Burkina Faso between 1996 and 1998 a nd patients were followed-up for 14 days. Sensitivity of isolates in vitro and whole blood levels of chloroquine and amodiaquine were also measured. T he primary efficacy parameter was parasitological clearance on day 14 (para sitological success). The secondary efficacy parameter was absence of signs /symptoms of malaria on day 14 (clinical success). Among the 364 patients r andomized and receiving the assigned treatment (chloroquine n = 185, amodia quine n = 179), 137 and 139, respectively, reached the primary endpoint. Am odiaquine proved significantly more effective than chloroquine. The summary odds ratio (95% CI) was 7 . 79 (4 . 54-13 . 35) for parasitological succes s, and 6 . 3 (3 . 4 -11 . 68) for clinical success. Sensitivity in vitro an d chloroquine blood levels were good predictors of chloroquine failure. Amo diaquine remains effective for treating uncomplicated falciparum malaria in areas of West and Central Africa where chloroquine resistance is prevalent . However, measures should be taken to protect the lifespan of amodiaquine where the drug is introduced for use.