Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.

Hdl Handle:
http://hdl.handle.net/10144/18366
Title:
Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.
Authors:
Checchi, F; Roddy, P; Kamara, S; Williams, A; Morineau, G; Wurie, A R; Hora, B; Lamotte, N; Baerwaldt, T; Heinzelmann, A; Danks, A; Pinoges, L; Oloo, A; Durand, R; Ranford-Cartwright, L; Smet, M
Journal:
Tropical Medicine & International Health
Abstract:
OBJECTIVES: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. METHODS: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. RESULTS: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. CONCLUSION: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ.
Affiliation:
Epicentre, 8 rue Saint-Sabin, 75011 Paris, France. francesco.checchi@lshtm.ac.uk
Publisher:
Wiley-Blackwell
Issue Date:
Feb-2005
URI:
http://hdl.handle.net/10144/18366
DOI:
10.1111/j.1365-3156.2004.01367.x
PubMed ID:
15679557
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorChecchi, F-
dc.contributor.authorRoddy, P-
dc.contributor.authorKamara, S-
dc.contributor.authorWilliams, A-
dc.contributor.authorMorineau, G-
dc.contributor.authorWurie, A R-
dc.contributor.authorHora, B-
dc.contributor.authorLamotte, N-
dc.contributor.authorBaerwaldt, T-
dc.contributor.authorHeinzelmann, A-
dc.contributor.authorDanks, A-
dc.contributor.authorPinoges, L-
dc.contributor.authorOloo, A-
dc.contributor.authorDurand, R-
dc.contributor.authorRanford-Cartwright, L-
dc.contributor.authorSmet, M-
dc.date.accessioned2008-02-14T17:10:04Z-
dc.date.available2008-02-14T17:10:04Z-
dc.date.issued2005-02-
dc.identifier.citationEvidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine. 2005, 10 (2):146-53 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid15679557-
dc.identifier.doi10.1111/j.1365-3156.2004.01367.x-
dc.identifier.urihttp://hdl.handle.net/10144/18366-
dc.description.abstractOBJECTIVES: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. METHODS: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. RESULTS: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. CONCLUSION: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAmodiaquineen
dc.subject.meshAnimalsen
dc.subject.meshAntimalarialsen
dc.subject.meshChild, Preschoolen
dc.subject.meshChloroquineen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Combinationsen
dc.subject.meshDrug Resistanceen
dc.subject.meshEvidence-Based Medicineen
dc.subject.meshFemaleen
dc.subject.meshHealth Policyen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshPlasmodium falciparumen
dc.subject.meshPyrimethamineen
dc.subject.meshSierra Leoneen
dc.subject.meshSulfadoxineen
dc.subject.meshTreatment Failureen
dc.subject.meshTreatment Outcomeen
dc.titleEvidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.en
dc.contributor.departmentEpicentre, 8 rue Saint-Sabin, 75011 Paris, France. francesco.checchi@lshtm.ac.uken
dc.identifier.journalTropical Medicine & International Healthen

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