title: Efficacy of chloroquine and sulfadoxine/pyrimethamine for the treatment of uncomplicated falciparum malaria in Koumantou, Mali.
abstract: We report the results of an in vivo antimalarial efficacy study with chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) conducted between 2003 and 2004 in Koumantou, southern Mali. A total of 244 children were included in the study; 210 children were followed-up for 28 days according to WHO recommendations, with PCR genotyping to distinguish late recrudescence from re-infection. Global failure proportions at Day 14, without taking into account re-infections, were 44.2% (95% CI 34.9-53.5%) in the CQ group and 2.0% (95% CI 0.0-4.8%) in the SP group. PCR-adjusted failure proportions at Day 28 were even higher in the CQ group (90.5% (95/105), 95% CI 84.8-96.2%) and relatively low in the SP group (7.0% (7/100), 95% CI 1.9-12.1%). These results show that CQ is no longer efficacious in Koumantou. The use of SP in monotherapy is likely to compromise its efficacy. We recommend the use of artemisinin-based combination therapy as first-line treatment for uncomplicated Plasmodium falciparum malaria in Koumantou.
authors.affiliation: Epicentre, 42 bis, Boulevard Richard Lenoir, 75011 Paris, France. xderadigues@epicentre.msf.org
authors.forename: Xavier
authors.initials: X
authors.lastname: de Radiguès
authors.forename: Kandian I
authors.initials: KI
authors.lastname: Diallo
authors.forename: Mouctar
authors.initials: M
authors.lastname: Diallo
authors.forename: Paul Akisa
authors.initials: PA
authors.lastname: Ngwakum
authors.forename: Hamma
authors.initials: H
authors.lastname: Maiga
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Djimdé
authors.forename: Massambou
authors.initials: M
authors.lastname: Sacko
authors.forename: Ogobara
authors.initials: O
authors.lastname: Doumbo
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guthmann
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D002738:Chloroquine / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011739:Pyrimethamine / Q000627:therapeutic use*; D012008:Recurrence; D012717:Sesquiterpenes / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use*; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; C031327:artemisinin; D011739:Pyrimethamine