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DRUG-RESISTANT MALARIA IN BANGUI, CENTRAL AFRICAN REPUBLIC: AN IN VITRO ASSESSMENT

We used an in vitro isotopic drug sensitivity assay to assess the sensitivity of Plasmodium falciparum isolates collected in Bangui, Central African Republic between March and July 2004. We tested antimalarials that are currently in use in this country (chloroquine, amodiaquine, quinine, and pyrimethamine), antimalarials that will become available in this region in the future (artemisinin and halofantrine), and prophylactic antimalarials (mefloquine, doxycycline, and atovaquone). The proportions of resistant isolates were 37% for chloroquine, 15.9% for amodiaquine, 0% for quinine, 0% for dihydroartemisinin, 1.6% for mefloquine, 3.8% for halofantrine, 4.0% for atovaquone, and 38.3% for pyrimethamine. No multi-resistant isolates (showing resistance to more than three drugs) were found. A positive correlation was found between the 50% inhibitory concentrations values for the following drugs: chloroquine and amodiaquine; quinine and halofantrine; chloroquine and dihydroartemisinin; chloroquine and halofantrine; amodiaquine and dihydroartemisinin; dihydroartemisinin and mefloquine; chloroquine and quinine; and quinine and dihydroartemisinin. These findings suggest that the Ministry of Health should recommend a interim policy with the amodiaquine plus sulfadoxine-pyrimethamine combination as the first-line antimalarial drug in Bangui until better alternative treatments such as artemisinin-based combination therapies become available at low prices in the Central African Republic.

Received October 4, 2004. Accepted for publication January 19, 2005.

Acknowledgments: We thank the patients and their parents or guardians for participating in this study, and the managers of the urban health centers in Bangui (Foyer de Charité; Dr. G. Service, Boy Rabe, and Dr. C. Begoua), and Dr. D. Senekian for their assistance. We are grateful to the members of the Groupe de Travail Malaria, Réseau International des Instituts Pasteur, especially Milijoana Randrianarivelojosia (Institut Pasteur, Antananarivo, Madagascar), Ronan Jambou (Institut Pasteur, Dakar, Senegal), Thierry Fandeur (Institut Pasteur du Cambodge, Phnom Penh, Cambodia), and Eric Legrand (Institut Pasteur de Guyanne, Cayenne, French Guiana) for their valuable assistance. We also thank Leonardo K. Basco, Pascal Ringwald, Hoffmann-La Roche, and SmithKline Beecham for providing the antimalarial drugs.

Financial support: This study was supported by the Pasteur Institute of Bangui and PAL+ (French Ministry of Foreign Affairs).

^* Address correspondence to Didier Menard, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar. E-mail: dmenard{at}pasteur.mg and didier.menard{at}laposte.net

Authors’ addresses: Didier Menard, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Madagascar, Telephone: 261-20-22-412-72, Fax: 261-20-22-415-34, E-mails: dmenard{at}pasteur.mg and didier.menard{at}laposte.net. Djibrine Djalle, Alexandre Manirakiza, Ferdinand Yapou, Valerie Siadoua, Serge Sana, Marcelle Diane Matsika-Claquin, and Antoine Talarmin, Pasteur Institute of Bangui, BP 923, Bangui, Central African Republic. Madji Nestor, National Malaria Control Program, Central African Republic Ministry of Health, Bangui, Central African Republic.

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