title: Molecular epidemiology of malaria in Cameroon. XXI. Baseline therapeutic efficacy of chloroquine, amodiaquine, and sulfadoxine-pyrimethamine monotherapies in children before national drug policy change.
abstract: 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 Chloroquine is no longer a viable option and has been withdrawn from the official drug outlets in Cameroon.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.
authors.affiliation: Institut de Recherche pour le Développement (IRD) , Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte contre les Endémies en Afrique Centrale (OCEAC), Yaoundé, Cameroon. lkbasco@yahoo.fr
authors.forename: Leonardo K
authors.initials: LK
authors.lastname: Basco
authors.forename: Vincent Foumane
authors.initials: VF
authors.lastname: Ngane
authors.forename: Mathieu
authors.initials: M
authors.lastname: Ndounga
authors.forename: Albert
authors.initials: A
authors.lastname: Same-Ekobo
authors.forename: Jean-Christian
authors.initials: JC
authors.lastname: Youmba
authors.forename: Raphael Therese Okalla
authors.initials: RT
authors.lastname: Abodo
authors.forename: Georges
authors.initials: G
authors.lastname: Soula
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use*; D004338:Drug Combinations; D006291:Health Policy; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D017720:Molecular Epidemiology; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine