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MOLECULAR EPIDEMIOLOGY OF MALARIA IN CAMEROON. XXI. BASELINE THERAPEUTIC EFFICACY OF CHLOROQUINE, AMODIAQUINE, AND SULFADOXINE-PYRIMETHAMINE MONOTHERAPIES IN CHILDREN BEFORE NATIONAL DRUG POLICY CHANGE

The availability of epidemiologic data on drug-resistant malaria based on a standardized clinical and parasitological protocol is a prerequisite for a rational therapeutic strategy to control malaria. As part of the surveillance program on the therapeutic efficacy of the first-line (chloroquine and amodiaquine) and second-line (sulfadoxine-pyrimethamine) drugs for the management of uncomplicated Plasmodium falciparum infections, non-randomized studies were conducted in symptomatic children aged less than 10 years according to the World Health Organization protocol (14-day follow-up period) at 12 sentinel sites in Cameroon between 1999 and 2004. Of 1,407 children enrolled in the studies, 460, 444, and 503 were treated with chloroquine, amodiaquine, or sulfadoxine-pyrimethamine, respectively. Chloroquine treatment resulted in high failure rates (proportion of early and late failures, 48.6%). Amodiaquine was effective at all study sites (proportion of failures, 7.3%). Sulfadoxine-pyrimethamine therapy was less effective than amodiaquine (P < 0.05), with failures observed in 9.9% of patients. Chloroquine is no longer a viable option and has been withdrawn from the official drug outlets in Cameroon. Amodiaquine and, to a lesser extent, sulfadoxine-pyrimethamine monotherapies are still effective in Cameroon, but further development of resistance to these drugs should be delayed by the novel strategy using artemisinin-based combination therapy. Our findings indicate that amodiaquine is the most rational partner for artesunate. Studies on the efficacy of artesunate-amodiaquine combination are currently being undertaken at several sites in the country.

Received October 24, 2005. Accepted for publication May 3, 2006.

Acknowledgments: The authors thank the personnel of dispensaries and hospitals for their aid in recruiting patients.

Financial support: This study was supported by the Regional Office for Africa, World Health Organization (Harare, Zimbabwe); Agence Universitaire de la Francophonie; Department of Cooperation, French Ministry of Foreign Affairs (Fonds d’Aide et de Coopération, Programme Mobilisateur Paludisme); and French Ministry of Research (Programme VIHPAL/PAL+).

^* Address correspondence to Leonardo Basco, OCEAC, B. P. 288, Yaoundé, Cameroon (Central Africa). E-mail: lkbasco{at}yahoo.fr

Authors’ addresses: Leonardo K. Basco, Mathieu Ndounga, Unité de Recherche "Paludologie Afro-tropicale," Institut de Recherche pour le Développement (IRD) and Laboratoire de Recherche sur le Paludisme, OCEAC, B. P. 288, Yaoundé, Cameroon. Vincent Foumane Ngane, Georges Soula, Laboratoire de Santé Publique, OCEAC, B. P. 288, Yaoundé, Cameroon. Albert Same-Ekobo, Laboratoire de Parasitologie, Faculté de Médecine, B. P. 3266, Yaoundé, Cameroon. Jean-Christian Youmba, Raphael Therese Okalla Abodo, Groupe Technique Central, Comité National Roll Back Malaria, Programme National de Lutte contre le Paludisme, Ministère de la Santé Publique, Yaoundé, Cameroon.

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