1921
Volume 70, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Congo is facing frequent failures of treatment of 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 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 malaria, at least in the settings of the present study.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.2004.70.133
2004-02-01
2019-12-06
Loading full text...

Full text loading...

/deliver/fulltext/14761645/70/2/0700133.html?itemId=/content/journals/10.4269/ajtmh.2004.70.133&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2000. Malaria. World Health Organ Tech Rep Ser 892.
  2. Le Bras J, Coulaud JP, Bricaire F, Le Bras M, Roué R, Fournon M, 1985. Chloroquine-resistant falciparum malaria in the Congo. Lancet ii : 1071. [Google Scholar]
  3. Carme B, Benthein F, Moudzeo H, Mbitsi A, Madzou G, 1986. Chimiorésistance de Plasmodium falciparum au Congo. Etude in vivo après 10 et 25 mg/kg de chloroquine (235 tests). Bull Soc Pathol Exot 79 : 490–502. [Google Scholar]
  4. Carme B, Moudzeo H, Mbitsi A, Sathounkasi C, Ndounga M, Brandicourt O, Gay F, Le Bras J, Gentilini M, 1990. La résistance médicamenteuse de Plasmodium falciparum au Congo. Bilan des enquêtes réalisées de 1985 à 1989. Bull Soc Pathol Exot 83 : 228–241. [Google Scholar]
  5. Chandenier J, Ndounga M, Carme B, Gay F, Mbitsi A, Hayette MP, Stanghellini A, Oko Ossoh J, Baudon D, Zitsamélé RC, 1995. Chimiosensibilité in vivo et in vitro de Plasmodium falciparum à Brazzaville (Congo). Cah Sante 5 : 25–29. [Google Scholar]
  6. Carme B, Ndounga M, Kissila AM, Samba G, Baya Tsika N, 1998. Niveau de chloroquinorésistance inchangé (Plasmodium falciparum) de 1986 à 1996 chez les enfants semi-immuns à Brazzaville (Congo). Bull Soc Pathol Exot 91 : 164–166. [Google Scholar]
  7. Trape JF, 2001. The public health impact of chloroquine resistance in Africa. Am J Trop Med Hyg 64 : 12–17. [Google Scholar]
  8. Bloland PB, Ettling M, 1999. Making malaria-treatment policy in the face of drug resistance. Ann Trop Med Parasitol 93 : 5–23. [Google Scholar]
  9. Wernsdorfer WH, 1994. Epidemiology of drug resistance in malaria. Acta Trop 56 : 143–156. [Google Scholar]
  10. Mackinnon MJ, 1997. Survival probability of drug resistant mutants in malaria parasites. Proc R Soc Lond B Biol Sci 264 : 53–59. [Google Scholar]
  11. WHO, 1996. Assessment of Therapeutic Efficacy of Antimalarial Drugs for Uncomplicated falciparum Malaria in Areas with Intense Transmission. Geneva: World Health Organization. WHO/MAL/96.1077.
  12. Basco LK, Same Ekobo A, Foumane Ngane V, Ndounga M, Metoh T, Ringwald P, Soula G, 2002. Therapeutic efficacy of sulfadoxine-pyrimethamine, amodiaquine and the sulfadoxine-pyrimethamine-amodiaquine combination against uncomplicated Plasmodium falciparum malaria in young children in Cameroon. Bull World Health Organ 80 : 538–545. [Google Scholar]
  13. Schmidt-Ott R, Luckner D, Lehman LG, Lell B, Matousek P, Greve B, Kresmer PG, 1997. Pyrimethamine/sulfadoxine for treating uncomplicated Plasmodium falciparum malaria in young children in Gabon. Trans R Soc Trop Med Hyg 91 : 578–579. [Google Scholar]
  14. Metzger W, Mordmuller B, Graninger W, Bienzle U, Kremsner PG, 1995. Sulfadoxine/pyrimethamine or chloroquine/ clindamycin treatment of Gabonese school children infected with chloroquine resistant malaria. J Antimicrob Chemother 36 : 723–728. [Google Scholar]
  15. Hodes RM, Wolday D, Kibreab T, 1997. Sensitivities of malaria in Zaire (letter). Trop Doct 27 : 190. [Google Scholar]
  16. White NJ, Nosten F, Looareesuwan S, Watkins WM, Marsh K, Snow RW, Kokwaro G, Ouma J, Hien TT, Molyneux ME, Taylor TE, Newbold CI, Ruebush TK II, Danis M, Greenwood BM, Anderson RM, Olliaro P, 1999. Averting a malaria disaster. Lancet 353 : 1965–1967. [Google Scholar]
  17. Tarimo DS, Minjas JN, Bygbjerg IC, 2002. Sulfadoxine-pyrimethamine monotherapy in Tanzanian children gives rapid parasite clearance that is improved by chloroquine in combination therapy. Trop Med Int Health 7 : 592–598. [Google Scholar]
  18. Stott GJ, Lewis SM, 1995. A simple and reliable method for estimating haemoglobin. Bull World Health Organ 73 : 369–373. [Google Scholar]
  19. Mount DL, Nahlen BL, Patchen LC, Churchill FC, 1989. Adaptations of the Saker-Solomons test: simple, reliable colorimetric field assays for chloroquine and its metabolites in urine. Bull World Health Organ 67 : 295–300. [Google Scholar]
  20. Talisuna AO, Langi P, Bakyaita N, Egwang T, Mutabingwa TK, Watkins W, Van Marck E, D’Alessandro U, 2002. Intensity of malaria transmission, antimalarial-drug use and resistance in Uganda: what is the relationship between these three factors. Trans R Soc Trop Med Hyg 96 : 310–317. [Google Scholar]
  21. Ringwald P, Same Ekobo A, Keundjian A, Kedy Mangamba D, Basco LK, 2000. Chemoresistance of P. falciparum in urban areas of Yaounde, Cameroon. Part 1: Surveillance of in vitro and in vivo resistance of Plasmodium falciparum to chloroquine from 1994 to 1999 in Yaounde, Cameroon. Trop Med Int Health 5 : 612–619. [Google Scholar]
  22. Guiyedi V, Koko J, Bouyou Akotet M, Mabika Manfoumbi M, Matsiégui PB, Traoré B, Kombila M, 2001. Evaluation de l’efficacité et de la tolérance de l’amodiaquine versus chloroquine dans le traitement de l’accès palustre simple chez l’enfant au Gabon. Bull Soc Pathol Exot 94 : 253–257. [Google Scholar]
  23. Brasseur P, Guiguemde R, Diallo S, Guiyedi V, Kombila M, Ringwald P, Olliaro P, 1999. Amodiaquine remains effective for treating uncomplicated malaria in west and central Africa. Trans R Soc Trop Med Hyg 93 : 645–650. [Google Scholar]
  24. Driessen GJ, Van Kerkhoven S, Schouwenberg BJ, Bonsu G, Verhave JP, 2002. Sulfadoxine/pyrimethamine: an appropriate first-line alternative for the treatment of uncomplicated falciparum malaria in Ghanaian children under 5 years of age. Trop Med Int Health 7 : 577–583. [Google Scholar]
  25. Tinto H, Zoungrana EB, Coulibaly SO, Ouedraogo JB, Traor_ M, Guiguemde TR, van Marck E, D’Alessandro U, 2002. Chloroquine and sulfadoxine-pyrimethamine efficacy for uncomplicated malaria treatment and haematological recovery in children in Bobo-Dioulasso, Burkina Faso during a 3-year period 1998–2000. Trop Med Int Health 7 : 925–930. [Google Scholar]
  26. Bojang KA, Schneider G, Forck S, Obaro SK, Jaffar S, Pinder M, Rowley J, Greenwood BM, 1998. A trial of Fansidar® plus chloroquine or Fansidar® alone for the treatment of uncomplicated malaria in Gambian children. Trans R Soc Trop Med Hyg 92 : 73–76. [Google Scholar]
  27. Staedke SG, Kamya MR, Dorsey G, Gasasira A, Ndeezi G, Charlebois ED, Rosenthal PJ, 2001. Amodiaquine, sulfadoxine/ pyrimethamine, and combination therapy for treatment of uncomplicated falciparum malaria in Kampala, Uganda: a randomised trial. Lancet 358 : 368–374. [Google Scholar]
  28. White NJ, 2002. The assessment of antimalarial drug efficacy. Trends Parasitol 18 : 458–464. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2004.70.133
Loading
/content/journals/10.4269/ajtmh.2004.70.133
Loading

Data & Media loading...

  • Received : 02 Jul 2003
  • Accepted : 22 Oct 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error