Molecular epidemiology of malaria in Cameroon. XXI. Baseline therapeutic efficacy of chloroquine, amodiaquine, and sulfadoxine-pyrimethamine monotherapies in children before national drug policy change

• Published in: The American journal of tropical medicine and hygiene Vol. 75; no. 3; p. 388
• Main Authors: Basco, Leonardo K, Ngane, Vincent Foumane, Ndounga, Mathieu, Same-Ekobo, Albert, Youmba, Jean-Christian, Abodo, Raphael Therese Okalla, Soula, Georges
• Format: Journal Article
• Language: English
• Published: United States 01-09-2006
• Subjects: Amodiaquine - therapeutic use; Antimalarials - therapeutic use; Cameroon - epidemiology; Child; Chloroquine - therapeutic use; Drug Combinations; Health Policy; Humans; Malaria, Falciparum - drug therapy; Molecular Epidemiology; Pyrimethamine - therapeutic use; Sulfadoxine - therapeutic use; Cameroon
• ISSN: 0002-9637
• DOI: 10.4269/ajtmh.2006.75.388

The availability of epidemiologic data on drug-resistant malaria based on a standardized clinical and parasitological protocol is a prerequisite for a rational therapeutic strategy to control malaria. As part of the surveillance program on the therapeutic efficacy of the first-line (chloroquine and amodiaquine) and second-line (sulfadoxine-pyrimethamine) drugs for the management of uncomplicated Plasmodium falciparum infections, non-randomized studies were conducted in symptomatic children aged less than 10 years according to the World Health Organization protocol (14-day follow-up period) at 12 sentinel sites in Cameroon between 1999 and 2004. Of 1,407 children enrolled in the studies, 460, 444, and 503 were treated with chloroquine, amodiaquine, or sulfadoxine-pyrimethamine, respectively. Chloroquine treatment resulted in high failure rates (proportion of early and late failures, 48.6%). Amodiaquine was effective at all study sites (proportion of failures, 7.3%). Sulfadoxine-pyrimethamine therapy was less effective than amodiaquine (P < 0.05), with failures observed in 9.9% of patients. Chloroquine is no longer a viable option and has been withdrawn from the official drug outlets in Cameroon. Amodiaquine and, to a lesser extent, sulfadoxine-pyrimethamine monotherapies are still effective in Cameroon, but further development of resistance to these drugs should be delayed by the novel strategy using artemisinin-based combination therapy. Our findings indicate that amodiaquine is the most rational partner for artesunate. Studies on the efficacy of artesunate-amodiaquine combination are currently being undertaken at several sites in the country.