title: Antimalarial efficacy of chloroquine, amodiaquine, sulfadoxine-pyrimethamine, and the combinations of amodiaquine + artesunate and sulfadoxine-pyrimethamine + artesunate in Huambo and Bie provinces, central Angola.
abstract: We studied three antimalarial treatments in Caala and Kuito, Angola, in 2002 and 2003. We tested chloroquine (CQ), amodiaquine (AQ) and sulfadoxine-pyrimethamine (SP) in Caala, and AQ, SP and the combinations AQ+artesunate (AQ+AS) and SP+artesunate (SP+AS) in Kuito. A total of 619 children (240 in Caala, 379 in Kuito) with uncomplicated Plasmodium falciparum malaria were followed-up for 28 days, with PCR genotyping to distinguish recrudescence from reinfection. PCR-corrected failure proportions at day 28 were very high in the CQ group (83.5%, 95% CI 74.1-90.5), high in the SP groups (Caala: 25.3%, 95% CI 16.7-35.8; Kuito: 38.8%, 95% CI 28.4-50.0), around 20% in the AQ groups (Caala: 17.3%, 95% CI 10.0-27.2; Kuito: 21.6%, 95% CI 14.3-30.6) and very low in the artemisinin-based combination groups (1.2%, 95% CI 0.0-6.4 for each combination AQ+AS and SP+AS). These results show that CQ and SP are no longer efficacious in Caala and Kuito and that the moderate efficacy of AQ is likely to be compromised in the short term if used as monotherapy. We recommend the use of AQ with AS, though this combination might not have a long useful therapeutic life because of AQ resistance.
authors.affiliation: Epicentre, 42 bis, Boulevard Richard Lenoir, 75011 Paris, France. jguthmann@epicentre.msf.org
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guthmann
authors.forename: Julia
authors.initials: J
authors.lastname: Ampuero
authors.forename: Filomeno
authors.initials: F
authors.lastname: Fortes
authors.forename: Chantal
authors.initials: C
authors.lastname: van Overmeir
authors.forename: Valérie
authors.initials: V
authors.lastname: Gaboulaud
authors.forename: Sophie
authors.initials: S
authors.lastname: Tobback
authors.forename: Jean
authors.initials: J
authors.lastname: Dunand
authors.forename: Nilton
authors.initials: N
authors.lastname: Saraiva
authors.forename: Philippe
authors.initials: P
authors.lastname: Gillet
authors.forename: Joan
authors.initials: J
authors.lastname: Franco
authors.forename: Anne
authors.initials: A
authors.lastname: Denoncin
authors.forename: Michel
authors.initials: M
authors.lastname: van Herp
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Dujardin
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
mesh_terms: D000655:Amodiaquine / Q000008:administration & dosage; D000810:Angola / Q000453:epidemiology; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage; D000077332:Artesunate; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011739:Pyrimethamine / Q000008:administration & dosage; D012717:Sesquiterpenes / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine