title: [Efficacy and safety of antimalarial combinations for treatment of uncomplicated malaria in children in Bangui, Central African Republic].
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy and safety of three anti-malarial combinations--artemether-lumefantrine (A-L), amodiaquine-sulfadoxine-pyrimethamine (AQ-SP), and artesunate-amodiaquine (AQ-AS)--in the treatment of uncomplicated malaria in children younger than 5 years in Bangui, Central African Republic.
  
  
  METHODS
  This study included 186 children aged 6-59 months with uncomplicated falciparum malaria who were treated at the Bédé Combattant Hospital from July through October 2010: 63 randomized to receive A-L, 63 AQ-SP, and 60 AQ-AS. Clinical outcome was classified according to WHO criteria as early treatment failure (ETF), late clinical failure (LCF), late parasitological failure (LPF), or adequate clinical and parasitological response (ACPR). The occurrence of mutations in the pfcrt, pfmdr-1, dhfr and dhps genes was studied by PCR-RFLP.
  
  
  RESULTS
  After PCR correction, ACPR at D28 was 100% for A-L, 96.55% for AQ-SP, and 100% for AQ-AS, with no significant difference between the three combinations (p = 0.36). The 2 cases of treatment failure for AQ-SP were associated with mutations at the following resistance markers: Pfcrt 76T, PfmdrI 86Y, Dhfr 108N, and Dhps A437. There was no significant difference in the reduction of anemia, fever (p = 0.87), or parasitemia (p = 0.63) between the three combinations.
  
  
  CONCLUSIONS
  This study demonstrates that artemisinin-based combinations are still effective and tolerated in the treatment of uncomplicated malaria in children younger than 5 years in Bangui. Treatment failures were due to new infections and mutations in resistance markers.
authors.affiliation: Unité d'immunologie, de biologie moléculaire et de biochimie, Laboratoire national de biologie et santé publique et de la population, Unité de chimiorésistance du paludisme, 1426 Bangui, République centrafricaine.
authors.forename: W S
authors.initials: WS
authors.lastname: Nambei
authors.forename: E
authors.initials: E
authors.lastname: Lango Yaya
authors.forename: S
authors.initials: S
authors.lastname: Pounguinza
authors.forename: O
authors.initials: O
authors.lastname: Achonduh
authors.forename: A
authors.initials: A
authors.lastname: Bogon
authors.forename: R
authors.initials: R
authors.lastname: Lengande
authors.forename: M-S
authors.initials: MS
authors.lastname: Evehe
authors.forename: A H
authors.initials: AH
authors.lastname: Ekollo Mbange
authors.forename: W
authors.initials: W
authors.lastname: Mbacham
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use; D002488:Central African Republic; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D026901:Membrane Transport Proteins / Q000235:genetics; D027425:ATP-Binding Cassette, Sub-Family C Proteins / Q000235:genetics; D009154:Mutation; D015800:Protozoan Proteins / Q000235:genetics; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000655:Amodiaquine; D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D026901:Membrane Transport Proteins; D027425:ATP-Binding Cassette, Sub-Family C Proteins; D015800:Protozoan Proteins; D011739:Pyrimethamine; D013413:Sulfadoxine; C513498:Mdr1 protein, Plasmodium falciparum; C416369:PfCRT protein, Plasmodium falciparum; C515299:amodiaquine, artesunate drug combination; C001205:fanasil, pyrimethamine drug combination
keywords: Central African Republic; amodiaquine-artesunate; amodiaquine-sulfadoxine-pyrimethamine; artemether-lumefantrine; uncomplicated malaria