Atovaquone-proguanil compared with chloroquine and chloroquine-sulfadoxine-pyrimethamine for treatment of acute Plasmodium falciparum malaria in the Philippines.
This randomized, open-label clinical trial compared a fixed-dose combination of atovaquone and proguanil (n=55) with chloroquine (n=23) or a combination of chloroquine, sulfadoxine, and pyrimethamine (n=32) for treatment of acute falciparum malaria in the Philippines. Patients were hospitalized for 28 days to ensure medication compliance and prevent reinfection. Atovaquone-proguanil produced a significantly higher cure rate (100%) compared with that for chloroquine (30.4%; P<.0001) or chloroquine-sulfadoxine-pyrimethamine (87.5%; P<.05). Treatments did not differ significantly with respect to parasite clearance time (mean: 46.7 h for atovaquone-proguanil, 60.0 h for chloroquine, and 42.8 h for chloroquine-sulfadoxine-pyrimethamine) or fever clearance time (mean, 38.8, 46.8, and 34.5 h, respectively). Adverse events were typical of malaria symptoms; the most frequently reported events were vomiting (18% for atovaquone-proguanil, 17% for chloroquine, and 9% for chloroquine-sulfadoxine-pyrimethamine), abdominal pain (15%, 17%, and 3%, respectively), anorexia (11%, 13%, and 0%, respectively), and headache (6%, 17%, and 3%, respectively). Atovaquone-proguanil was well tolerated and more effective than chloroquine or chloroquine-sulfadoxine-pyrimethamine for treatment of multidrug-resistant falciparum malaria in the Philippines.
Bustos
D G
DG
Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa, Metro Manila 1770, Philippines.
Canfield
C J
CJ
Canete-Miguel
E
E
Hutchinson
D B
DB
D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone; D002738:Chloroquine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D009285:Naphthoquinones / Q000627:therapeutic use*; D010679:Philippines; D002727:Proguanil / Q000627:therapeutic use*; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use
D000962:Antimalarials; D005493:Folic Acid Antagonists; D009285:Naphthoquinones; D013413:Sulfadoxine; D002738:Chloroquine; D002727:Proguanil; D053626:Atovaquone; D011739:Pyrimethamine