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EFFICACY OF SULFADOXINE/PYRIMETHAMINE IN THE TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN REPUBLIC OF CONGO

Congo is facing frequent failures of treatment of Plasmodium falciparum malaria with chloroquine (CQ), which is still recommended and used as a first-line drug. In Pointe-Noire and Brazzaville, the two largest cities that contain approximately 60% of the population of Congo, we compared the efficacy of CQ versus sulfadoxine/pyrimethamine (SP) for treatment of uncomplicated malaria in children 6–59 months old (mean = 33 months) using the standard World Health Organization (WHO) 14-day in vivo test in two phases between 1999 and 2002. Patients enrolled were randomly assigned to receive SP (25 mg/kg of sulfadoxine and 1.25 mg/kg of pyrimethamine) or CQ (25 mg/kg). In the first phase of the study, 46 patients were assigned to the CQ (n = 23) or SP (n = 23) groups in Pointe-Noire and 52 children were assigned to the CQ (n = 26) or to SP (n = 26) groups in Brazzaville. Results were interpreted according to the WHO lot quality assurance sampling method, and treatment failure rates for SP versus CQ were < 25% versus > 25% in both cities. In the second phase of the study, we accurately determined the actual proportion of treatment failures for SP in Brazzaville. Thus, in 75 of the 80 children enrolled and followed-up until day 14, no clinical or parasitologic failure was recorded and no serious adverse reaction was observed. Since the CQ treatment failure rate exceeds the unacceptable upper limit, SP seems well to be an appropriate alternative for the first-line treatment of uncomplicated P. falciparum malaria, at least in the settings of the present study.

Received July 2, 2003. Accepted for publication October 22, 2003.

Acknowledgments: We are grateful to local health authorities for their contribution to this study. We also grateful to Professor Fidèle Yala and Dr. Antoine Mbitsi (Department of Microbiology and Immunology, Brazzaville University, Brazzaville, Congo) for their material aid. Thanks are given to Professor Dominique Baudon (European Center of Humanitarian Health, Lyon, France) for his excellent assistance and his comments on this manuscript. We also thank Dr. Pascal Ringwald (Tropical Diseases Research, World Health Organization, Geneva, Switzerland) and Dr. Philippe Deloron (Institut de Recherche pour le Développement, Paris, France) for their invaluable advice.

Financial support: This work was supported by the University Agency of the French-Speaking World (Paris), the Institute of African Medicine and Epidemiology (Paris), Roche Laboratories (Paris), and the PAL+ Program (French Ministry for Research).

Authors’ addresses: Basile Nsimba, Frédéric Louya, Joseph Oko-Ossho, and Stanislas Ebata-Mongo, National Malaria Control Program, Division for Disease Control, Ministry of Health, Brazzaville, Congo. David A. Malonga and Maurice Malanda, Department of Paediatrics, Makélékélé Hospital, Brazzaville, Congo. Andre M. Mouata and Jeannine Kiori, Department of Paediatrics, Tié-Tié Hospital, Pointe-Noire, Congo. Dominique Yocka, Jane Vialle Health Center, Ouenzé, Brazzaville, Congo. Jacques Le Bras, National Malaria Reference Center, Bichat-Claude Bernard Hospital, 75018 Paris, France and Laboratory of Parasitology, University of Paris V, Paris, France.

Reprint requests: Basile Nsimba, National Malaria Control Program, Division for Disease Control, Ministry of Health, PO Box 2846, Brazzaville, Congo, E-mail: basilensimba{at}aol.com.

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