Efficacy of sulfadoxine-pyrimethamine, amodiaquine, and sulfadoxine-pyrimethamine-amodiaquine combination for the treatment of uncomplicated falciparum malaria in the urban and suburban areas of Brazzaville (Congo).

Abstract

Congo-Brazzaville has recently adopted artesunate-amodiaquine as the first-line antimalarial drug to replace chloroquine. Before the implementation of this new strategy, we conducted several clinical studies to assess the therapeutic efficacy of former, classical first-line antimalarial drugs in the city of Brazzaville, in which reside about 30% of the Congolese population. From 2003 to 2005, non-randomised trials were conducted to evaluate the efficacy of sulfadoxine-pyrimethamine (SP) (n=97 patients), amodiaquine (AQ) (n=62 patients), and the combination of sulfadoxine-pyrimethamine-amodiaquine (n=54 patients) in children aged between 6 months and 5 years with uncomplicated malaria using the 2003 WHO guidelines during the 28-day follow-up period. After excluding new infections by PCR, the proportion of treatment failure on day 28 was 30.2% (95% confidence interval, 19.2-43.0%) for sulfadoxine-pyrimethamine, 34.8% (95% confidence interval, 21.4-50.2%) for amodiaquine, and 14.2% (95% confidence interval, 5.9-27.2%) for sulfadoxine-pyrimethamine+amodiaquine combination. Treatment with sulfadoxine-pyrimethamine was associated with an increase of gametocyte charge. These results suggest that neither sulfadoxine-pyrimethamine nor amodiaquine is efficacious as monotherapy and that their combination may not remain effective in the coming years. Based on our results, the implementation of artemisinin-based combination therapy appears to be urgent in the country.

• Authors: Mathieu Ndounga, Pembe Issamou Mayengue, Rachida Tahar, Prisca N Casimiro, Davy W Matondo Maya, Valentine Miakassissa-Mpassi, David A Malonga, Freddy Nsonde-Ntandou, Godefroy Mallanda, Pascal Ringwald, Leonardo K Basco, Francine Ntoumi
• Journal: Acta tropica (Acta Trop) Vol. 103 Issue 3 Pg. 163-71 (Sep 2007) ISSN: 0001-706X [Print] Netherlands
• PMID: 17645863 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• DNA, Protozoan
• Drug Combinations
• Amodiaquine
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Pyrimethamine

Topics

• Amodiaquine (therapeutic use)
• Antimalarials (therapeutic use)
• Carrier State (diagnosis, parasitology)
• Child, Preschool
• Congo
• DNA, Protozoan (blood)
• Drug Combinations
• Drug Therapy, Combination
• Female
• Humans
• Infant
• Malaria, Falciparum (drug therapy)
• Male
• Pyrimethamine (therapeutic use)
• Sulfadoxine (therapeutic use)
• Treatment Outcome