Efficacy of sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in southern Mauritania.
BACKGROUND
Until 2006, the Mauritanian Ministry of Health recommended chloroquine and sulfadoxine-pyrimethamine for first- and second-line treatment of uncomplicated malaria, respectively. This study assessed the clinical efficacy of sulfadoxine-pyrimethamine in Kobeni as first-line treatment.


METHODS
This study included 55 patients with Plasmodium falciparum infections, who were treated with sulfadoxine-pyrimethamine and followed up for 28 days. Isolates were genotyped to distinguish between recrudescence and reinfection. Treatment success rates and survival were analysed per protocol to evaluate drug efficacy.


RESULTS
After inclusion, 2 patients were excluded for protocol violations, and 3 patients were lost to follow-up. Of the remaining 50 patients (per protocol population), 43 (86%) had adequate clinical and parasitological responses. Of the 7 patients with treatment failure, 5 (10%) were early failures, while 2 (4%) had initially responded and had late clinical failure on day 7, associated with recrudescence. With the exception of one adult weighing 91 kg, all treatment failures occurred in children aged from 7 to 12 years.


CONCLUSIONS
Sulfadoxine-pyrimethamine monotherapy was moderately effective but insufficiently reliable in view of the relatively high rate of early treatment failure. The high prevalence of chloroquine resistance found in earlier studies and the results of the present study on sulfadoxine-pyrimethamine justify the change in national policy and systematic use of artemisinin-based combination therapy for first-line treatment of P. falciparum malaria in Mauritania.
Institut national de recherches en santé publique, BP 695, Nouakchott, Mauritanie.
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Ouldabdallahi
Centre régional de formation et de recherches en génomiques et biostatistique, Dakar, Sénégal.
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Sarr
Unité de recherche 198, Institut de recherche pour le développement (IRD), Unité de recherche sur les maladies infectieuses et tropicales emergentes (Urmite), faculté de médecine La Timone, Aix-Marseille Université, Marseille, France.
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Basco
Programme national de lutte contre le paludisme, ministère de la Santé, Nouakchott, Mauritanie.
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Lebatt
Institut national de recherches en santé publique, BP 695, Nouakchott, Mauritanie.
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Lo
Service de parasitologie-mycologie, faculté de médecine, université Cheikh Anta Diop, BP 7325, Dakar, Sénégal.
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Gaye
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008435:Mauritania; D008875:Middle Aged; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D017211:Treatment Failure; D055815:Young Adult
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine
4-aminoquinolines; Mauritania; Plasmodium falciparum; antifolate drugs; clinical trial; drug resistance