title: Efficacy of chloroquine, sulfadoxine-pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria among children under five in Bongor and Koumra, Chad.
abstract: 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.
authors.affiliation: Epicentre, 8 Rue Saint Sabin, 75011 Paris, France. francesco.grandesso@epicentre.msf.org
authors.forename: Francesco
authors.initials: F
authors.lastname: Grandesso
authors.forename: Catherine
authors.initials: C
authors.lastname: Bachy
authors.forename: Issa
authors.initials: I
authors.lastname: Donam
authors.forename: John
authors.initials: J
authors.lastname: Ntambi
authors.forename: Joseph
authors.initials: J
authors.lastname: Habimana
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Jacob
authors.initials: J
authors.lastname: Maikere
authors.forename: Veerle
authors.initials: V
authors.lastname: Vanlerberghe
authors.forename: Clément Hinzoumbe
authors.initials: CH
authors.lastname: Kerah
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guthmann
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000818:Animals; D002596:Chad; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use*; D004338:Drug Combinations; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D017125:Genes, Protozoan; D005838:Genotype; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D021261:Parasitic Sensitivity Tests; D010963:Plasmodium falciparum / Q000235:genetics; D011446:Prospective Studies; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D014505:Urban Population
chemical_list: D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine