Varying efficacy of artesunate+amodiaquine and artesunate+sulphadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in the Democratic Republic of Congo: a report of two in-vivo studies.

Abstract

BACKGROUND:

Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005.

METHODS:

The results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission.

RESULTS:

Out of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6-35.5] and 15.1% [95% CI: 8.6-25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0-46.7] for SP and 18.3% [95% CI: 11.6-28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4-32.7] for SP monotherapy.

CONCLUSION:

The finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country.

• Authors: Maryline Bonnet, Ingrid van den Broek, Michel van Herp, Pedro Pablo Palma Urrutia, Chantal van Overmeir, Juliet Kyomuhendo, Célestin Nsibu Ndosimao, Elizabeth Ashley, Jean-Paul Guthmann
• Journal: Malaria journal (Malar J) Vol. 8 Pg. 192 (Aug 10 2009) ISSN: 1475-2875 [Electronic] England
• PMID: 19664280 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Drug Combinations
• amodiaquine, artesunate drug combination
• Amodiaquine
• fanasil, pyrimethamine drug combination
• Artesunate
• Sulfadoxine
• Pyrimethamine

Topics

• Amodiaquine (therapeutic use)
• Antimalarials (therapeutic use)
• Artemisinins (therapeutic use)
• Artesunate
• Child
• Child, Preschool
• Democratic Republic of the Congo
• Drug Combinations
• Female
• Humans
• Infant
• Malaria, Falciparum (drug therapy)
• Male
• Pyrimethamine (therapeutic use)
• Sulfadoxine (therapeutic use)
• Treatment Failure
• Treatment Outcome