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

Hdl Handle:
http://hdl.handle.net/10144/116332
Title:
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
Authors:
Bonnet, Maryline; Broek, Ingrid van den; van Herp, Michel; Urrutia, Pedro Pablo Palma; van Overmeir, Chantal; Kyomuhendo, Juliet; Ndosimao, Célestin Nsibu; Ashley, Elizabeth; Guthmann, Jean-Paul
Journal:
Malaria Journal
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.
Affiliation:
Epicentre, Geneva, Switzerland; Epicentre, Paris, France; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Médecins Sans Frontières, Brussels, Belgium; Médecins Sans Frontières, Barcelona, Spain; Prince Leopold Institute of Tropical Medicine, Department of Parasitology, Antwerp, Belgium; Mbarara University of Science and Technology, Mbarara, Uganda; National Malaria Control Programme, Kinshasa, Democratic Republic of Congo; Unité des Maladies à Prévention Vaccinale, Département des Maladies Infectieuses, Institut de Veille Sanitaire, Saint-Maurice cedex, France
Issue Date:
8-Oct-2009
URI:
http://hdl.handle.net/10144/116332
DOI:
10.1186/1475-2875-8-192
PubMed ID:
19664280
Additional Links:
http://www.malariajournal.com/content/8/1/192
Type:
Article
Language:
en
ISSN:
1475-2875
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorBonnet, Marylineen
dc.contributor.authorBroek, Ingrid van denen
dc.contributor.authorvan Herp, Michelen
dc.contributor.authorUrrutia, Pedro Pablo Palmaen
dc.contributor.authorvan Overmeir, Chantalen
dc.contributor.authorKyomuhendo, Julieten
dc.contributor.authorNdosimao, Célestin Nsibuen
dc.contributor.authorAshley, Elizabethen
dc.contributor.authorGuthmann, Jean-Paulen
dc.date.accessioned2010-11-25T16:05:46Z-
dc.date.available2010-11-25T16:05:46Z-
dc.date.issued2009-10-08-
dc.identifier.citationMalar. J. 2009;8:192en
dc.identifier.issn1475-2875-
dc.identifier.pmid19664280-
dc.identifier.doi10.1186/1475-2875-8-192-
dc.identifier.urihttp://hdl.handle.net/10144/116332-
dc.description.abstractBACKGROUND: 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.en
dc.language.isoenen
dc.relation.urlhttp://www.malariajournal.com/content/8/1/192en
dc.rightsPublished by BioMed Central, [url]http://www.malariajournal.com/[/url] Archived on this site by Open Access permissionen
dc.subject.meshAmodiaquineen
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshDemocratic Republic of the Congoen
dc.subject.meshDrug Combinationsen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshPyrimethamineen
dc.subject.meshSulfadoxineen
dc.subject.meshTreatment Failureen
dc.subject.meshTreatment Outcomeen
dc.titleVarying 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 studiesen
dc.typeArticleen
dc.contributor.departmentEpicentre, Geneva, Switzerland; Epicentre, Paris, France; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Médecins Sans Frontières, Brussels, Belgium; Médecins Sans Frontières, Barcelona, Spain; Prince Leopold Institute of Tropical Medicine, Department of Parasitology, Antwerp, Belgium; Mbarara University of Science and Technology, Mbarara, Uganda; National Malaria Control Programme, Kinshasa, Democratic Republic of Congo; Unité des Maladies à Prévention Vaccinale, Département des Maladies Infectieuses, Institut de Veille Sanitaire, Saint-Maurice cedex, Franceen
dc.identifier.journalMalaria Journalen

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