Atovaquone and proguanil versus amodiaquine for the treatment of Plasmodium falciparum malaria in African infants and young children. Clin Infect Dis 37: 1441

Malaria-related morbidity and mortality are greatest among young children in areas with high malaria trans-mission intensity. An open-label, randomized study was done to evaluate the efficacy and safety of the com-bination of atovaquone and proguanil formulated as pediatric-strength tablets (20 and 8 mg/kg of body weight, respectively, administered once daily for 3 days), compared with amodiaquine (10 mg/kg of body weight, once daily for 3 days), among children weighing 5 and!11 kg in Gabon. Two hundred patients aged 3–43 months were recruited. Use of atovaquone/proguanil resulted in a cure rate on day 28 of 95 % (87 of 92 children), compared with 53 % (41 of 78 children) for amodiaquine (difference, 42%; 95 % CI, 30%–54%;). TheP!.001 incidence of adverse events was similar in both groups, and no serious adverse events were attributed to the use of atovaquone/proguanil. Atovaquone/proguanil was found to be highly effective and safe for the treatment of Plasmodium falciparum malaria in infants and young children weighing 5–10 kg in Africa. The combination of atovaquone, a hydroxynaphtho-quinone, with the biguanid proguanil has demonstrated excellent cure rates in the treatment of uncomplicated Plasmodium falciparum malaria [1–3] and is highly ef-fective in curing multidrug-resistant falciparum malaria