Dramatically decreased therapeutic efficacy of chloroquine and sulfadoxine-pyrimethamine, but not mefloquine, in southern Benin.
OBJECTIVE
To evaluate the in vivo therapeutic efficacy of chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and mefloquine (MQ) in children presenting with uncomplicated malaria in Benin.


METHODS
Drug efficacy was tested according to the WHO in vivo 28-day protocol. For failures that occurred after 7 days of follow-up, paired pre- and post-treatment blood samples were genotyped at msp1 and msp2 loci to distinguish new infections and recrudescent strains. Children enrolled were randomly assigned to a therapeutic group (CQ, n=14; SP, n=42; MQ, n=44). The number of CQ treatment was intentionally restricted after 1 month, as its use was considered to constitute a danger for children.


RESULTS
Chloroquine and SP showed very high failure rates (85.7% and 50%, respectively), whereas MQ treatment was successful in 97.5%. The molecular tool allowed to re-evaluate two new infections previously considered as failures.


CONCLUSIONS
Chloroquine should no longer be used to treat children presenting with Plasmodium falciparum malaria in Benin.
Aubouy
Agnès
A
Research Unit 010 (UR010), Mother and Child Health in the Tropics, Development Research Institute (IRD), Cotonou, Benin. agnes.aubouy@ird.fr
Fievet
Nadine
N
Bertin
Gwladys
G
Sagbo
Jean C
JC
Kossou
Hortense
H
Kinde-Gazard
Dorothée
D
Kiniffo
Richard
R
Massougbodji
Achille
A
Deloron
Philippe
P
D000284:Administration, Oral; D000818:Animals; D000953:Antigens, Protozoan / Q000235:genetics; D000962:Antimalarials / Q000008:administration & dosage*; D001541:Benin / Q000453:epidemiology; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage*; D016054:DNA, Protozoan / Q000032:analysis; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage*; D020066:Merozoite Surface Protein 1 / Q000235:genetics; D010963:Plasmodium falciparum / Q000235:genetics; D011110:Polymorphism, Genetic; D015800:Protozoan Proteins / Q000235:genetics; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage*; D017211:Treatment Failure; D016896:Treatment Outcome
D000953:Antigens, Protozoan; D000962:Antimalarials; D016054:DNA, Protozoan; D004338:Drug Combinations; D020066:Merozoite Surface Protein 1; D015800:Protozoan Proteins; C065974:merozoite surface protein 2, Plasmodium; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D015767:Mefloquine; D011739:Pyrimethamine