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

• Published in: Research and reports in tropical medicine Vol. 8; pp. 85 - 104
• Main Authors: Kshirsagar, Nilima A, Gogtay, Nithya J, Moran, Diego, Utz, Gregory, Sethia, Ashok, Sarkar, Shirsendu, Vandenbroucke, Pol
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2017; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Acute; Antibiotics; antimalarial; Azithromycin; Chloroquine; Clinical Trial Report; Dosage and administration; Drug therapy; Erythrocytes; Health aspects; Internet; Malaria; parasitologic cure rate; plasmodium; Plasmodium falciparum; Risk factors; Studies; uncomplicated malaria; Young adults; India; South America; Brazil; Colombia; Mumbai India; United States > US; chloroquine; acute; parasitologic cure rate; plasmodium; uncomplicated malaria; azithromycin; antimalarial; malaria
• ISSN: 1179-7282; 1179-7282
• DOI: 10.2147/RRTM.S129741

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 1 g and chloroquine (CQ) 600 mg base once daily (QD) for 3 days versus atovaquone-proguanil (AP) or chloroquine plus sulfadoxine-pyrimethamine (SPCQ) in adults with acute uncomplicated malaria. Patients were hospitalized until three documented negative blood smears and followed through Day 42. The primary end point was parasitologic cure at Day 28. 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 2 g dose of azithromycin and 600 mg of CQ in India and Colombia resulted in an overall efficacy rate of 97%. In India, Colombia, and Suriname, 1 g azithromycin with CQ QD for 3 days was inferior to established comparator agents. An improved response rate was observed when the dose of azithromycin was increased to 2 g.