Beyond Chloroquine: Implications of Drug Resistance for Evaluating Malaria Therapy Efficacy and Treatment Policy in Africa

Abstract

Emphasis on retaining chloroquine as the first-line therapy for Plasmodium falciparum infections in most of sub-Saharan Africa for as long as it remains effective has resulted in widespread reliance on chloroquine in areas where it can have little effect on P. falciparum parasitemia. To address this issue, clinical, parasitologic, and hematologic responses to chloroquine or pyrimethamine/sulfadoxine treatment were assessed among very young children in Malawi (n = 153) and Kenya (n = 73). The median time to resumption of clinical symptoms in chloroquine-treated children was 13.5 days in Malawi and 9.5 days in Kenya. Children treated with pyrimethamine/sulfadoxine maintained clinical improvement and had greater increases in their hemoglobin concentration during the follow-up period than did children treated with chloroquine. Treatment with chloroquine failed to produce either a durable clinical improvement or optimal hematologic recovery. Consequently, chloroquine can no longer be considered adequately effective therapy of clinical P. falciparum malaria in very young children in these areas of Africa.

A systematic approach to the development of a rational malaria treatment policy in Zambia

“…(Bloland et al 1993). All children р 5 years of age seeking outpatient care at the study facilities with an axillary temperature у 37.5 ЊC underwent screening.…”

“…In 1973, the World Health Organization (WHO) recommended a 7-day test which incorporated *Use of trade names is for identification only and does not imply endorsement by the U.S. Public Health Service or by the Department of Health and Human Services. clinical response into it's outcome measures (WHO 1973). Although simpler and less expensive to conduct, the major drawback of this procedure was that it did not assess clinical failures after Day 7, which some studies suggested also significantly contributed to malaria-related morbidity and mortality (Khoromana et al 1986;Greenberg et al 1989;Campbell 1991;Bloland et al 1993). A 14-day follow-up study was proposed that permitted, with limited additional cost, a more complete assessment of clinical response.…”

Chloroquine and sulphadoxine‐pyrimethamine efficacy for uncomplicated malaria treatment and haematological recovery in children in Bobo‐Dioulasso, Burkina Faso during a 3‐year period 1998–2000

“…CQ resistance seems to have spread more rapidly in Eastern than in Western Africa (Bloland et al 1993;Bakyaita 2000). In Burkina Faso the national malaria control programme still recommends CQ as the first and sulfadoxine-pyrimethamine (SP) as the second-line drug.…”

Antimalarial Drug Resistance: Surveillance and Molecular Methods for National Malaria Control Programmes

“…Unfortunately, the criteria on which this decision can be taken are not clear (Bloland et al 1993). The standard methods to assess the efficacy of a given drug can be divided in two broad groups: in vivo and in vitro tests.…”