Amodiaquine for treating malaria.
Olliaro P., Mussano P.
BACKGROUND:Amodiaquine has been widely used to treat malaria. Due to reports of fatal adverse drug reactions, discontinuation or modification of its use has been suggested. OBJECTIVES:The objective of this review was to assess the effects of amodiaquine for treating malaria. SEARCH STRATEGY:We searched the Cochrane Infectious Diseases Group trials register and Medline. We also contacted researchers in the field and drug companies. SELECTION CRITERIA:Randomised and quasi-randomised trials comparing amodiaquine with other treatment for uncomplicated malarial infections in adults and children. DATA COLLECTION AND ANALYSIS:Both reviewers independently extracted data and assessed trial quality. MAIN RESULTS:Forty trials were included. Allocation was adequately concealed in three trials. Amodiaquine was more effective than chloroquine for parasite clearance. The combined results of parasite clearance at seven days from 24 trials was 83% for amodiaquine and 56% for chloroquine (odds ratio 4.29, 95% confidence interval 3.51 to 5.24). The odds ratio for parasite clearance at 14 days was 6.00, 95% confidence interval 4.38 to 8.21. Amodiaquine and sulfadoxine/pyrimethamine showed similar results for parasite clearance on day seven, but sulfadoxine/pyrimethamine appeared to be more effective on day 14 and 28. No significant difference for adverse events was observed between amodiaquine and chloroquine and sulfadoxine/pyrimethamine. Reported adverse effects were minor or moderate, not life threatening. REVIEWER'S CONCLUSIONS:There is some evidence to support the continued use of amodiaquine in the treatment of uncomplicated malaria, although drug resistance should be considered. Monitoring for toxicity should also continue.