Research

Efficacy and safety of artesunate plus amodiaquine in routine use for the treatment of uncomplicated malaria in Casamance, southern Sénégal

Philippe Brasseur¹ , Patrice Agnamey² , Oumar Gaye³ , Michel Vaillant^4,5 , Walter RJ Taylor^6,7 and Piero L Olliaro^5,7

¹  UR 077, IRD, Dakar, Sénégal

²  Laboratoire de Parasitologie-Mycologie CHU Amiens, France

³  Faculté de Médecine, Université Cheikh Anta Diop, Dakar, Sénégal

⁴  Clinical Epidemiology and Public Health Unit, Center for Health Studies, CRP-Santé, Luxembourg

⁵  Unité 3677, Bases thérapeutiques des inflammations et infections, Université Victor Segalen Bordeaux 2, Bordeaux, France

⁶  Travel and Migration Medicine Unit, Geneva University Hospital, Geneva, Switzerland

⁷  UNICEF/UNDP/WB/WHO Special Programme for Research & Training in Tropical Diseases (TDR), 20 avenue Appia, CH1211 Geneva 27, Switzerland

author email corresponding author email

Malaria Journal 2007, 6:150doi:10.1186/1475-2875-6-150

Published:	15 November 2007

Abstract

Background

There are no data on the long term use of an artemisinin combination treatment in moderate or high transmission areas of Africa.

Methods and findings

Artesunate plus amodiaquine (AS+AQ) was used to treat slide-proven Plasmodium falciparum-infected patients of all ages in the Oussouye district, Casamance, Senegal, over a period of six years (2000 to 2005). Efficacy, by Kaplan Meier survival analysis (n = 966), and safety (adverse event rates, n = 752) were determined over 28 days. A weight-based dosing regimen was used for the loose tablets during 2000–2003 (n = 731) and a commercially available co-blister was used during 2004–2005 (n = 235).

Annual crude (non PCR corrected) rates remained stable over the study period [range 88.5–96.7%; overall 94.6 (95% CI 92.9–95.9)]. Nine co-blister treated patients (0.9%) withdrew because of drug-related adverse events; seven had gastrointestinal complaints of whom two were hospitalized for vomiting. By Day 28, the mean total bilirubin (n = 72), AST (n = 94) and ALT (n = 95) values decreased. Three patients had Day 28 AST/ALT values > 40 < 200 IU/L. Changes in white cell counts were unremarkable (n = 87).

Conclusion

AS+AQ in combination was highly efficacious and well-tolerated in this area and justifies the decision to use it as first line treatment. Long-term monitoring of safety and efficacy should continue.