Efficacy of chloroquine, sulfadoxine–pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria among children under five in Bongor and Koumra, Chad

We report two 28-day in-vivo antimalarial efficacy studies carried out in the urban centres of Bongor and Koumra, southern Chad. We assess chloroquine (CQ), sulfadoxine–pyrimethamine (SP) and amodiaquine (AQ) to treat Plasmodium falciparum uncomplicated malaria. Methods and outcome classification co...

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Published in:	Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 100; no. 5; pp. 419 - 426
Main Authors:	Grandesso, Francesco, Bachy, Catherine, Donam, Issa, Ntambi, John, Habimana, Joseph, D’Alessandro, Umberto, Maikere, Jacob, Vanlerberghe, Veerle, Kerah, Clément Hinzoumbe, Guthmann, Jean-Paul
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier Ltd 01-05-2006 Royal Society of Tropical Medicine and Hygiene Elsevier
Subjects:	Amodiaquine Amodiaquine - therapeutic use Animals Biological and medical sciences Chad Child, Preschool Chloroquine Chloroquine - therapeutic use Drug Combinations Drug Resistance Drug Therapy, Combination Genes, Protozoan Genotype Human protozoal diseases Humans Infant Infectious diseases Malaria Malaria, Falciparum - drug therapy Medical sciences Parasitic diseases Parasitic Sensitivity Tests Plasmodium falciparum Plasmodium falciparum - genetics Prospective Studies Protozoal diseases Pyrimethamine - therapeutic use Resistance Sulfadoxine - therapeutic use Sulfadoxine–pyrimethamine Treatment Outcome Urban Population Chad Africa Resistance Plasmodium falciparum Malaria Chloroquine Amodiaquine Chad Sulfadoxine–pyrimethamine Sulfanilamide derivatives Antimalarial Protozoal disease Amine Tropical medicine Antiinfectious Sulfadoxine Antirheumatic agent Child Human Protozoa Apicomplexa Drug combination Pyrimethamine Quinoline derivatives Parasitosis Infection Chemotherapy Treatment Parasiticide Sulfadoxine- pyrimethamine Antibacterial agent
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Summary:	We report two 28-day in-vivo antimalarial efficacy studies carried out in the urban centres of Bongor and Koumra, southern Chad. We assess chloroquine (CQ), sulfadoxine–pyrimethamine (SP) and amodiaquine (AQ) to treat Plasmodium falciparum uncomplicated malaria. Methods and outcome classification complied with latest WHO guidelines. Out of the 301 and 318 children aged 6−59 months included in Bongor and Koumra, respectively, 246 (81.7%) and 257 (80.8%) were eligible for analysis. In Bongor and Koumra, the 28-day PCR-adjusted failure rates for CQ were 23.7% (95% CI 14.7–34.8%) and 32.9% (95% CI 22.1–45.1%), respectively, and those for SP were 16.3% (95% CI 9.4–25.5%) and 4.3% (95% CI 1.2–10.5%). AQ failure rates were 6.4% (95% CI 2.1–14.3%) and 2.2% (95% CI 0.3–7.6%). The current use of CQ in Bongor and Koumra is questionable, and a more efficacious treatment is needed. Considering the reduced efficacy of SP in Bongor, AQ seems to be the best option for the time being. Following WHO recommendations that prioritize the use of artemisinin-based combinations, artesunate plus amodiaquine could be a potential first-line treatment. Nevertheless, the efficacy of this combination should be evaluated and the change carefully prepared, implemented and monitored.
Bibliography:	Present address: Prince Leopold Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. ark:/67375/HXZ-CWLMHNRJ-C istex:F135715FB37B90A45CEB3DF92173903C9B722FBA ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0035-9203 1878-3503
DOI:	10.1016/j.trstmh.2005.07.017