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Increasing resistance to chloroquine necessitates the evaluation of other antimalarial therapies in Africa. We compared the efficacies of amodiaquine (AQ), sulfadoxine-pyrimethamine (SP), and AQ + SP for the treatment of uncomplicated falciparum malaria in a randomized trial of patients 6 months of age or older in Bobo-Dioulasso, Burkina Faso. Of the 944 patients enrolled, 829 (88%; 53% under 5 years of age) were assigned 28-day efficacy outcomes. For all regimens, early treatment failures were uncommon (< 2%). Considering all treatment failures based on WHO criteria, AQ + SP was most efficacious (failures in 4.2%), followed by SP (9.1%) and AQ (17.9%; P < 0.02 for all pairwise comparisons). Considering only clinical failures, relative efficacies were similar (failures in 2.1% with AQ + SP, 6.5% with SP, and 13.2% with AQ; P < 0.02 for all pairwise comparisons). The risk of recrudescence was lower with AQ + SP (2.1%) compared with SP (6.1%, P = 0.02) and AQ (8.1%, P = 0.001). Risks of new infection were lower with AQ + SP (2.1%) and SP (2.4%) compared with AQ (9.1%, P < 0.001 for both comparisons). No serious adverse events were seen. AQ + SP appears to offer a highly effective, inexpensive, and available therapy for the treatment of uncomplicated malaria in Burkina Faso.
Received April 20, 2005. Accepted for publication June 6, 2005.
Acknowledgments: The authors thank the clinical study teams in the dispensaries of Colsama (Minata Yampa, Christine Ouaro Sylvain Zoundi), Sarlafao (Georgette Dabire, Gneme Moumouni), and Ouezzin-Ville (Yolande Sanou, Korotoumou Sontie, Aissiata Boly) and the laboratory technicians (Patrice Hien, Adama Sankara, Daouda Traore, San Coulibaly, Mahamoudou Minoungou). We also thank Assobga Franck Godefroy, Harouna Zigani, and Halidou Tinto for assistance with data entry and Heidi Hopkins for assistance in protocol preparation.
Financial support: This work was supported by grant D43 TW01506 from the Fogarty International Center of the National Institutes of Health.
* Address correspondence to Philip J. Rosenthal, Box 0811, University of California, San Francisco, CA 94143. E-mail: rosnthl{at}itsa.ucsf.edu
Authors addresses: Issaka Zongo, Noel Rouamba, Moise Lankoande, and Jean-Bosco Ouedraogo, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso. Grant Dorsey, Christian Dokomajilar, and Philip J. Rosenthal, Box 0811, University of California, San Francisco, CA 94143.
Reprint requests: Philip J. Rosenthal, Box 0811, University of California, San Francisco, CA 94143, Telephone: 1-415-206-8845, Fax: 1-415-648-8425, E-mail: rosnthl{at}itsa.ucsf.edu.
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