Treatment of uncomplicated malaria in Africa: evaluation of randomized clinical trials

Malaria is a major devastating infectious diseases in tropical countries. The resistance of P. falciparum to the traditional antimalarial drugs is believed to be contributing to increased malaria mortality.

The purpose of this study is to evaluate randomized clinical trials of uncomplicated P. faciparum malaria with the hope of providing recent scientific evidence on the current antimalarial drugs that would be effective, safe, affordable and available in Africa.

We reviewed articles based only on data collected between 2005 and 2009 and randomized clinical trials of uncomplicated P. faciparum malaria in Africa published between January 2006 and August 2009. Relevant articles were sourced using data available from PubMed Central, NCBI, NEJM, BMJ, Google, and Biomed Central. Data were analysed to determine the best outcomes of treatment.

Sixty-two articles were identified as relevant. Twenty of these, involving 2967 patients, met our inclusion criteria. Three (3), 4, 3, 1, 3, 2 and 4 of the articles were based on chloroquine, sulphadoxine/pyrimethamine, amodiaquine, quinine, artemether-lumefantrine, artesunate plus sulphadoxine/pyrimethamine, and artesunate plus amodiaquine, respectively. The respective mean cure rates for these drugs were 66.7 +/- 28.4%, 72.0 +/- 35.6%, 83.0 +/- 24.3%, 64.0%, 95.4 +/- 0.56%, 97.4%, and 88.2 +/- 13.0%. While artemisinin combination therapy (ACT) remained highly effective across countries, there was no evidence of the effectiveness of chloroquine in most parts of the continent. No serious side effects was reported by ACT.

ACT remains the best antimalarial for the treatment of uncomplicated P. falciparum malaria in Africa. Clinical trials on current state of the effectiveness of chloroquine in the various countries of the continent is recommended to be able to understand whether chloroquine needs to be returned for the effective treatment of uncomplicated malaria in the region.