Free Content Dramatically decreased therapeutic efficacy of chloroquine and sulfadoxine-pyrimethamine, but not mefloquine, in southern Benin

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Abstract:

Summary Objective  To evaluate the therapeutic efficacy of chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and mefloquine (MQ) in children presenting with uncomplicated malaria in Benin. Methods  Drug efficacy was tested according to the WHO 28-day protocol. For failures that occurred after 7 days of follow-up, paired pre- and post-treatment blood samples were genotyped at and loci to distinguish new infections and recrudescent strains. Children enrolled were randomly assigned to a therapeutic group (CQ,  = 14; SP,  = 42; MQ,  = 44). The number of CQ treatment was intentionally restricted after 1 month, as its use was considered to constitute a danger for children. Results  Chloroquine and SP showed very high failure rates (85.7% and 50%, respectively), whereas MQ treatment was successful in 97.5%. The molecular tool allowed to re-evaluate two new infections previously considered as failures. Conclusions  Chloroquine should no longer be used to treat children presenting with malaria in Benin.

French
Objectif 

Evaluer l'efficacité thérapeutique in vivo de la chloroquine (CQ), de la sulfadoxine-pyriméthamine (SP) et de la méfloquine (MQ) chez les enfants présentant un paludisme simple au Bénin. Méthodes 

L'efficacité des médicaments a étéétudiée in vivo pendant 28 jours selon le protocole de l'OMS. Pour les échecs survenus après 7 jours de suivi, des échantillons de sang appariés prélevés avant et après traitement ont été génotypés au niveau des loci msp1 et msp2 afin de distinguer les nouvelles infections des souches recrudescentes. Les enfants enrôlés ont été aléatoirement affectés à un groupe thérapeutique (CQ, n = 14; SP, n = 42; MQ, n = 44). Le nombre de traitements à la CQ a été intentionnellement limité après un mois car son utilisation a été considérée comme dangereuse pour les enfants. Résultats 

CQ et la SP ont démontré des taux d’échec très élevés (85,7 et 50% respectivement), tandis que le traitement à la MQ était efficace dans 97,5% des cas. L'outil moléculaire a permis de réévaluer deux nouvelles infections précédemment considérées comme des échecs. Conclusions 

La chloroquine ne devrait plus être utilisée pour traiter les enfants présentant un paludisme simple àP. falciparum au Bénin.

Keywords: Benin; bénin; chloroquine; cloroquina; drug efficacy; efficacité du médicament; eficacia medicamentos; falciparum malaria; malaria falciparum; mefloquina; mefloquine; méfloquine; paludisme falciparum; sulfadoxina-pirimetamina; sulfadoxine-pyrimethamine; sulfadoxine-pyriméthamine

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2007.01859.x

Affiliations: 1:  Research Unit 010 (UR010), Mother and Child Health in the Tropics, Development Research Institute (IRD), Cotonou, Benin 2:  UR010 IRD, Paris, France 3:  Ministry of Public Health, Cotonou, Benin 4:  Parasitology and Mycology Education and Research Unit, Health Sciences Faculty, Cotonou, Benin

Publication date: July 1, 2007

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