Many countries in Africa are now confronted with the dilemma of shifting
drug policies for uncomplicated
falciparum malaria from
chloroquine, which has become largely ineffective, to a new first-line
drug and
amodiaquine is one 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 performed in Senegal, Cameroon, Gabon, and Burkina Faso between 1996 and 1998 and patients were followed-up for 14 days. Sensitivity of isolates in vitro and whole blood levels of
chloroquine and
amodiaquine were also measured. The primary efficacy parameter was parasitological clearance on day 14 (parasitological success). The secondary efficacy parameter was absence of signs/symptoms of
malaria on day 14 (clinical success). Among the 364 patients randomized and receiving the assigned treatment (
chloroquine n = 185,
amodiaquine n = 179), 137 and 139, respectively, reached the primary endpoint.
Amodiaquine proved significantly more effective than
chloroquine. The summary odds ratio (95% CI) was 7.79 (4.54-13.35) for parasitological success, and 6.3 (3.4-11.68) for clinical success. Sensitivity in vitro and
chloroquine blood levels were good predictors of
chloroquine failure.
Amodiaquine 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.