Volume 88, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The objectives of this study were: 1) to evaluate the safety and efficacy of combination artesunate (AS)/amodiaquine (AQ) therapy, and 2) to determine the difference between recrudescence and resistance. An efficacy study was conducted in Equatorial Guinea. A total of 122 children 6–59 months of age from two regional hospitals were randomized and subjected to a 28-day clinical and parasitological follow-up. A blood sample on Whatman paper was taken on Days 0, 7, 14, 21, and 28 or on any day in cases of treatment failure, with the parasite DNA then being extracted for molecular analysis purposes. A total of 4 children were excluded, and 9 cases were lost to follow-up. There were 17 cases of late parasitological failure, 3 cases of late clinical failure, and 89 cases of adequate clinical and parasitological response. The parasitological failure rate was 18.3% (20 of 109) and the success rate 81.70% (95% confidence interval [72.5–87.9%]). After molecular correction, real treatment efficacy stood at 97.3%. Our study showed the good efficacy of combination AS/AQ therapy. This finding enabled this treatment to be recommended to Equatorial Guinea's National Malaria Control Program to change the official treatment policy as of March 2008.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Article metrics loading...

Loading full text...

Full text loading...



  1. Breman J, Alilio M, Mills A, , 2004. Conquering the intolerable burden of malaria: what's new, what's needed: a summary. Am J Trop Med Hyg 71: 115.
  2. WHO, 2008. World Malaria Report. Geneva: World Health Organization.
  3. RBM, 2003. Malaria in Pregnancy. Roll Back Malaria. Geneva: World Health Organization.
  4. WHO, 2007. Malaria in Pregnancy. Geneva: World Health Organization.
  5. WHO, 2001. Drug Resistance in Malaria. Geneva: World Health Organization.
  6. Roche J, Guerra-Neira A, Raso J, Benito A, , 2003. Surveillance of in vivo resistance of Plasmodium falciparum to antimalarial drugs from 1992 to 1999 in Malabo (Equatorial Guinea). Am J Trop Hyg 68: 598601.
  7. Charle P, Berzosa P, Descalzo MA, de Lucio A, Raso J, Obono J, Lwanga N, Nlang N, Nchama A, Mangue C, Micha A, Nsee N, Mesie R, Benito A, Roche J, , 2009. Efficacy of artesunate + sulfadoxine-pyrimethamine (AS + SP) and amodiaquine + sulfadoxine-pyrimethamine (AQ + SP) for uncomplicated falciparum malaria in Equatorial Guinea (Central Africa). J Trop Med. doi:10.1155/2009/78186.
  8. WHO, 2001. Antimalarial Drug Combination Therapy. Geneva: World Health Organization.
  9. Robert F, Ntoumi F, Angel G, Candito D, Rogier C, Fandeur T, Sarthou JL, Mercereau-Puijalon O, , 1996. Extensive genetic diversity of Plasmodium falciparum isolates collected from patients with severe malaria in Dakar, Senegal. Trans R Soc Trop Med Hyg 90: 704711.[Crossref]
  10. Mwangi JM, Omar SA, Ranford-Cartwright LC, , 2006. Comparison of microsatellite and antigen-coding loci for differentiating recrudescing Plasmodium falciparum infections from reinfections in Kenya. Int J Parasitol 36: 329336.[Crossref]
  11. Kleinschmidt I, Torrez M, Schwabe C, Benavente L, Seocharan I, Jituboh D, Nseng G, Sharp B, , 2007. Factors influencing the effectiveness of malaria control in Bioko island, Equatorial Guinea. Am J Trop Med Hyg 76: 10271032.
  12. WHO, 2003. Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria. Geneva: World Health Organization.
  13. Rubio JM, Benito A, Berzosa PJ, Roche J, Puente S, Subirats M, López-Vélez R, García L, Alvar J, , 1999. Usefulness of seminested multiplex PCR in surveillance of imported malaria in Spain. J Clin Microbiol 37: 32603264.
  14. WHO, 2004. Excel Sheet for Resistance Data Collection. Geneva: World Health Organization.
  15. iDND, 2007. ASAQ registration update. Drugs for Neglected Diseases Initiative, Geneva, Switzerland.
  16. WHO, 2006. International Drug Price Indicator. Geneva: World Health Organization.
  17. WHO/AFRO, 2007. Antimalarial Drug Policies. Geneva: World Health Organization/AFRO.
  18. Ibrahium AM, Kheir MM, Osman ME, Khalik IF, Alifrangis M, Elmardi KA, Malik EM, Adam I, , 2007. Efficacies of artesunate plus either sulfadoxine-pyrimethamine or amodiaquine, for the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan. Ann Trop Med Parasitol 101: 1521.[Crossref]
  19. Sowunmi A, Fehintola FA, Adedeji AA, Gbotosho GO, Tambo E, Fateye BA, Happi TC, Oduola AM, , 2005. Open randomized study of artesunate-amodiaquine vs. chloroquine-pyrimethamine-sulfadoxine for the treatment of uncomplicated Plasmodium falciparum malaria in Nigerian children. Trop Med Int Health 10: 11611170.[Crossref]
  20. Kabanywanyi AM, Mwita A, Sumari D, Gbotosho GO, Tambo E, Fateye BA, Happi TC, Oduola AM, , 2007. Efficacy and safety of artemisinin-based antimalarial in the treatment of uncomplicated malaria in children in southern Tanzania. Malar J 6: 46.[Crossref]
  21. Dorsey G, Staedke S, Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Dokomajilar C, Kamya MR, Rosenthal PJ, , 2007. Combination therapy for uncomplicated falciparum malaria in Ugandan children: a randomized trial. JAMA 297: 22102219.[Crossref]
  22. Faye B, Ndiaye JL, Ndiaye D, Dieng Y, Faye O, Gaye O, , 2007. Efficacy and tolerability of four antimalarial combinations in the treatment of uncomplicated Plasmodium falciparum malaria in Senegal. Malar J 6: 80.[Crossref]
  23. Ndiaye JL, Faye B, Diouf AM, Kuété T, Cisse M, Seck PA, Brasseur P, Same-Ekobo A, Lameyre V, Gaye O, , 2008. Randomized, comparative study of the efficacy and safety of artesunate plus amodiaquine, administered as a single daily intake versus two daily intakes in the treatment of uncomplicated falciparum malaria. Malar J 7: 16.[Crossref]

Data & Media loading...

  • Received : 08 May 2012
  • Accepted : 30 Nov 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error