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This paper reports a two-phase study in Bangui, Central African Republic (CAR): first, we assessed the clinical efficacy to chloroquine (CQ), sulfadoxine-pyrimethamine (SP), and amodiaquine (AQ), then we tested the efficacy of two combinations: CQ + SP and AQ + SP. We used the standard 14-day WHO 2001 protocol to compare therapeutic responses in children under 5 years of age with acute uncomplicated Plasmodium falciparum malaria in Bangui between February 2002 and March 2004. The overall treatment failure rates with CQ, AQ, SP, CQ + SP, and AQ + SP were 40.9%, 20.0%, 22.8%, 7.2%, and 0%. These findings suggest that the Ministry of Health should recommend an interim policy with AQ + SP combination as the first-line antimalarial drug in Bangui until best alternative treatments like artemisinin-based combination therapies (ACTs) become available at low prices in the CAR.
Received May 27, 2004. Accepted for publication November 2, 2004.
Acknowledgments: The authors thank the patients and their parents or guardians for participating in the study and the managers of the urban health centers in Bangui (Foyer de Charité, Boy Rabe, Begoua).
Financial support: This study was supported by the Pasteur Institute of Bangui and PAL+ (French Ministry of Foreign Office).
Authors’ addresses: Didier Menard, Alexandre Minirakiza, Djibrine Djalle, and Antoine Talarmin, Malaria Unit, Institute Pasteur de Madagascar, BP 1274-ANTANANARIVO 101, Telephone: 261-20-22-412-72, Fax: 261-20-22-415-34, E-mail: dmenard{at}pasteur.mg. Nestor Madji and Max Roger Koula, National Malaria Contorl Program, Ministry of Health, BP 711-Bangui, Central African Republic.
Reprint requests: Didier Menard, Ambassade de France en RCA, Institut Pasteur de Bangui, 128 bis rue de l’université, 75351 Paris 07 SP, Telephone: 00 236 61 86 84, Fax: 00 236 61 01 09, E-mail: dmenard{at}pasteur-bangui.org, didier.menard{at}laposte.net.
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