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 falciparum malaria to amodiaquine (35 mg/kg) and sulfadoxine-pyrimethamine (sulfadoxine, 25 mg/kg) in symptomatic outpatients at 2 sites in northern and western Kenya during 1993. Of the 239 patients recruited, 181 (76%) completed the study [84 (46%) on amodiaquine and 97 (54%) on sulfadoxine-pyrimethamine]. There were no significant differences in the parasitological, clinical 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-pyrimethamine in the west. In both sites defervescence was significantly more rapid with amodiaquine (P < 0.05) and true clinical failure (symptomatic illness with recurrent parasitaemia) was unusual (9%). As high-level resistance to chloroquine is widespread, both drugs are valuable alternatives. However, the significantly higher levels of resistance in the west may be a sign of the increased drug pressure in this holoendemic area and send an important warning concerning resistance to sulfadoxine-pyrimethamine.
van Dillen
J
J
Department of Social Medicine, Medical Faculty, University of Amsterdam, The Netherlands.
Custers
M
M
Wensink
A
A
Wouters
B
B
van Voorthuizen
T
T
Voorn
W
W
Khan
B
B
Muller
L
L
Nevill
C
C
D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007630:Kenya; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy*; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage*; D013997:Time Factors
D000962:Antimalarials; D006454:Hemoglobins; D000655:Amodiaquine; D013413:Sulfadoxine; D011739:Pyrimethamine