Chloroquine or amodiaquine combined with sulfadoxine-pyrimethamine for treating uncomplicated malaria

Abstract

Background: Amodiaquine and chloroquine give fast relief from malaria symptoms, particularly fever. When used alone in areas where there is some parasite resistance they do not completely clear parasites from the blood in all cases, and so not all patients are cured of infection. The major disadvantage of using sulfadoxine-pyrimethamine alone is that it takes a relatively long time to relieve fever.

Objectives: To assess the effectiveness of chloroquine or amodiaquine given with sulfadoxine-pyrimethamine to treat uncomplicated falciparum malaria.

Search strategy: The Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Science Citation Index, African Index Medicus and LILACS were searched. Experts in the field and drug companies were contacted.

Selection criteria: Randomised and quasi-randomised trials of chloroquine or amodiaquine given with sulfadoxine-pyrimethamine compared with either drug alone in adults or children with confirmed uncomplicated falciparum malaria.

Data collection and analysis: Two people independently applied the inclusion criteria. Data were extracted by the reviewer and checked independently by another person.

Main results: Seven trials were included (1277 patients in total). Fever clearance time was shortened by combination therapy compared to sulfadoxine-pyrimethamine alone. Parasite clearance at day seven follow-up was not significantly different for chloroquine or amodiaquine treatment with or without sulfadoxine-pyrimethamine. Parasite clearance at day 28 was better with combination therapy compared to chloroquine or amodiaquine alone, but not significantly better than sulfadoxine-pyrimethamine alone. There was no evidence from the included trials of serious side effects with combination treatment.

Reviewer's conclusions: In areas where chloroquine or amodiaquine are still effective, despite some degree of resistance, using these drugs in combination with sulfadoxine-pyrimethamine, rather than sulfadoxine-pyrimethamine alone, may make people feel better faster and improve sustained parasites clearance.