title: Efficacy of artesunate-amodiaquine for the treatment of acute uncomplicated falciparum malaria in southern Mauritania.
abstract: BACKGROUND
  A regular evaluation of therapeutic efficacy in sentinel sites and a system of surveillance are required to establish treatment guidelines and adapt national anti-malarial drug policy to the rapidly changing epidemiology of drug-resistant malaria. The current anti-malarial treatment guideline in Mauritania, officially recommended since 2006, is based on artemisinin-based combination therapy. The aim of the present study was to evaluate clinical efficacy and tolerance of artesunate-amodiaquine, the first-line treatment for acute uncomplicated malaria, in Mauritanian paediatric and adult patients to validate its continued use in the country.
  
  
  METHODS
  Plasmodium falciparum-infected symptomatic patients aged > six months were enrolled in Kobeni and Timbedra in southern Mauritania in September to October 2013. Co-formulated artesunate-amodiaquine was administered at the recommended dose over three days. Patients were followed until day 28. Parasitological and clinical response was classified according to the standard 2009 World Health Organization protocol.
  
  
  RESULTS
  A total of 130 patients (65 in Kobeni and 65 in Timbedra) were enrolled in the study. Seventeen patients (13.1%) were either excluded (before PCR correction) or lost to follow-up. Based on the per protocol analysis, artesunate-amodiaquine efficacy (i.e., the proportion of adequate clinical and parasitological response) was 96.6% in Kobeni and 98.2% in Timbedra before PCR correction. Late clinical failure was observed in two patients in Kobeni and one patient in Timbedra. After PCR correction, the efficacy rate in the two study sites was 98.2%. On day 3, all patients were afebrile and had negative smears. Treatment was well tolerated.
  
  
  CONCLUSIONS
  Artesunate-amodiaquine is well tolerated and highly efficacious for the treatment of uncomplicated P. falciparum malaria. In the majority of patients, fever and parasitaemia were rapidly cleared before day 3. The results support the national anti-malarial drug guideline for a continued use of artesunate-amodiaquine as a first-line drug for uncomplicated malaria in southern Mauritania.
authors.affiliation: Unité de Recherche « Génsome et Milieux », Faculté des Sciences et Techniques, Université des Sciences, de Technologie et de Médecine, Nouakchott, Mauritania. hmoukah2002@yahoo.fr.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ouldabdallahi
authors.forename: Ismail
authors.initials: I
authors.lastname: Alew
authors.forename: Mohamed Salem Ould Ahmedou
authors.initials: MS
authors.lastname: Salem
authors.forename: Mamadou
authors.initials: M
authors.lastname: Dit Dialaw Ba
authors.forename: Ali Ould Mohamed Salem
authors.initials: AO
authors.lastname: Boukhary
authors.forename: Mohamed Lemine Ould
authors.initials: ML
authors.lastname: Khairy
authors.forename: Mohamed Boubacar Abdel
authors.initials: MB
authors.lastname: Aziz
authors.forename: Pascal
authors.initials: P
authors.lastname: Ringwald
authors.forename: Leonardo K
authors.initials: LK
authors.lastname: Basco
authors.forename: Saidou Doro
authors.initials: SD
authors.lastname: Niang
authors.forename: Sid Mohamed
authors.initials: SM
authors.lastname: Lebatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000655:Amodiaquine / Q000008:administration & dosage* / Q000009:adverse effects; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology / Q000473:pathology; D008297:Male; D008435:Mauritania; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine