Efficacy of sulfadoxine-pyrimethamine, amodiaquine, and sulfadoxine-pyrimethamine-amodiaquine combination for the treatment of uncomplicated falciparum malaria in the urban and suburban areas of Brazzaville (Congo).
Congo-Brazzaville has recently adopted artesunate-amodiaquine as the first-line antimalarial drug to replace chloroquine. Before the implementation of this new strategy, we conducted several clinical studies to assess the therapeutic efficacy of former, classical first-line antimalarial drugs in the city of Brazzaville, in which reside about 30% of the Congolese population. From 2003 to 2005, non-randomised trials were conducted to evaluate the efficacy of sulfadoxine-pyrimethamine (SP) (n=97 patients), amodiaquine (AQ) (n=62 patients), and the combination of sulfadoxine-pyrimethamine-amodiaquine (n=54 patients) in children aged between 6 months and 5 years with uncomplicated malaria using the 2003 WHO guidelines during the 28-day follow-up period. After excluding new infections by PCR, the proportion of treatment failure on day 28 was 30.2% (95% confidence interval, 19.2-43.0%) for sulfadoxine-pyrimethamine, 34.8% (95% confidence interval, 21.4-50.2%) for amodiaquine, and 14.2% (95% confidence interval, 5.9-27.2%) for sulfadoxine-pyrimethamine+amodiaquine combination. Treatment with sulfadoxine-pyrimethamine was associated with an increase of gametocyte charge. These results suggest that neither sulfadoxine-pyrimethamine nor amodiaquine is efficacious as monotherapy and that their combination may not remain effective in the coming years. Based on our results, the implementation of artemisinin-based combination therapy appears to be urgent in the country.
Ndounga
Mathieu
M
Laboratoire de Pharmacologie, Centre d'Etudes sur les Ressources Végétales, Brazzaville, Congo. ngoualandounga@yahoo.fr
Mayengue
Pembe Issamou
PI
Tahar
Rachida
R
Casimiro
Prisca N
PN
Matondo Maya
Davy W
DW
Miakassissa-Mpassi
Valentine
V
Malonga
David A
DA
Nsonde-Ntandou
Freddy
F
Mallanda
Godefroy
G
Ringwald
Pascal
P
Basco
Leonardo K
LK
Ntoumi
Francine
F
D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D002353:Carrier State / Q000175:diagnosis / Q000469:parasitology; D002675:Child, Preschool; D003223:Congo; D016054:DNA, Protozoan / Q000097:blood; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome
D000962:Antimalarials; D016054:DNA, Protozoan; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine