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COMPARISON OF THE PARASITOLOGIC EFFICACY OF AMODIAQUINE AND SULFADOXINE-PYRIMETHAMINE IN THE TREATMENT OF PLASMODIUM FALCIPARUM MALARIA IN THE BUNGOMA DISTRICT OF WESTERN KENYA

The efficacy of amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) was assessed in 310 symptomatic children from western Kenya with uncomplicated Plasmodium falciparum malaria. A non-blinded, randomized, 14-day study was performed and parasitologic criteria were used. Of 310 patients included, 238 (77%) completed the study: 120 received AQ and 118 received SP. In those treated with AQ, there were sensitive (S) infections in 107 patients (89.2%, 95% confidence interval [CI] = 82.2, 94.1%), RI resistance in 10 (8.3%, 95% CI = 4.1, 14.8%), RII resistance in 1 (0.8%, 95% CI = 0, 4.6%), and RIII resistance in 2 (1.7%, 95% CI = 0.2, 5.9%). In those treated with SP, there were S infections in 74 patients (62.7%, 95% CI = 53.3, 71.4%), RI resistance in 21 (17.8%, 95% CI = 11.4, 25.9%), RII resistance in 11 (9.3%, 95% CI = 4.7, 16.1%), and RIII resistance in 12 (10.2%, 95% CI = 5.4, 17.1%). Resistance rates were consistently higher in the SP-treated patients (P < 0.001). Resistance to SP in this area has reached such levels that it should no longer be the first-line treatment. Alternative treatment, such as SP plus AQ combination treatment or artemisinin combination treatment, is urgently needed.

Received July 2, 2003. Accepted for publication May 28, 2004.

Acknowledgments: We thank those who supported this malaria research project, especially AMREF East-Africa, the Sirisia Health Center, the Webuya Panpaper Clinic, and Bungoma Hospital in the Bungoma District of Kenya. We are grateful to Dr. J. Reesink and Dr. D. van de Wetering for their work in Kenya.

Financial support: This study was supported by AMREF, the Spinoza Fund (Amsterdam University Society), and the Department of Infectious Diseases, Tropical Medicine and AIDS (Academic Medical Center, Amsterdam).

Authors’ addresses: C. J. Vreugdenhil, F. Y. Scheper, S. R. Hoogstraatte, and M. Smolders, Faculty of Medicine and Department of Infectious Diseases, Tropical Medicine and AIDS, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. S. Gikunda, Malaria Unit, African Medical and Research Foundation, Nairobi, Kenya. F. G. Cobelens and P. A. Kager, Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, F4-217, PO Box 22, 660 1000 DD Amsterdam, The Netherlands, Telephone: 31-20-566-4380, Fax: 31-20-697-2286, E-mail: p.a.kager{at}amc.uva.nl.

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