Treatment of adults with acute uncomplicated malaria with azithromycin and chloroquine in India, Colombia, and Suriname

• Main Authors: Kshirsagar NA, Gogtay NJ, Moran D, Utz G, Sethia A, Sarkar S, Vandenbroucke P
• Format: Article in Journal/Newspaper
• Language: English
• Published: Dove Medical Press 2017
• Subjects: Acute; uncomplicated malaria; antimalarial; azithromycin; chloroquine; malaria; parasitologic cure rate; plasmodium; Arctic medicine. Tropical medicine; RC955-962; Arctic
• Online Access: https://doaj.org/article/675960046f0c42e78b6ffc866a9e20d0

Nilima A Kshirsagar,1 Nithya J Gogtay,1 Diego Moran,2 Gregory Utz,3 Ashok Sethia,4 Shirsendu Sarkar,5 Pol Vandenbroucke6 1Seth G S Medical College and KEM Hospital, Mumbai, India; 2Hospital San Andrés de Tumaco, Narino, Colombia; 3US Naval Medical Research Unit 6, Lima, Peru; 4Gita Bhawan Hospital and Research Centre, Indore, 5Pfizer, Mumbai, India; 6Pfizer, New York, NY, USA Background: To explore the use of azithromycin–chloroquine (AZCQ) for the treatment of malaria, we conducted double-blind, randomized, non-inferiority studies in India, Colombia, and Suriname comparing the combination of azithromycin 1g and chloroquine (CQ) 600mg base once daily (QD) for 3days versus atovaquone–proguanil (AP) or chloroquine plus sulfadoxine–pyrimethamine (SPCQ) in adults with acute uncomplicated Plasmodium falciparum malaria.Methods: Patients were hospitalized until three documented negative blood smears and followed through Day 42. The primary end point was parasitologic cure at Day 28.Results: In India, parasite clearance rates were 84% and 94% for AZCQ and SPCQ, respectively (95% confidence interval [CI] for the difference: –22.6, 0.8). In Colombia and Suriname, parasite clearance rates were 57% and 99% for AZCQ and AP, respectively (95% CI: –52, –32). A subsequent open-label, non-comparative third study using a 2g dose of azithromycin and 600mg of CQ in India and Colombia resulted in an overall efficacy rate of 97%.Conclusion: In India, Colombia, and Suriname, 1g azithromycin with CQ QD for 3days was inferior to established comparator agents. An improved response rate was observed when the dose of azithromycin was increased to 2g. Keywords: acute, uncomplicated malaria, antimalarial, azithromycin, chloroquine, malaria, parasitologic cure rate, plasmodium