Sensitivity of Plasmodium falciparum to quinolines and therapeutic strategies: comparison of the situation in Africa and Madagascar between 1983 and 1986

One thousand and twenty six P. falciparum strains isolated from cases imported in France and field surveys in four regions of Africa and Madagascar were studied in vitro against chloroquine, monodesethylamodiaquine, quinine and mefloquine, 917 in vivo tests were performed during field studies with c...

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Published inBulletin de la Societe de pathologie exotique et de ses filiales Vol. 80; no. 3 Pt 2; p. 477
Main Authors Le Bras, J, Simon, F, Ramanamirija, J A, Calmel, M B, Hatin, I, Deloron, P, Porte, J, Marchais, H, Clausse, J L, Biaud, J M
Format Journal Article
LanguageFrench
Published France 1987
Subjects
Amodiaquine - analogs & derivatives
Amodiaquine - therapeutic use
Angola
Animals
Antimalarials - therapeutic use
Burkina Faso
Cameroon
Chloroquine - therapeutic use
Drug Resistance
Humans
Madagascar
Malaria - drug therapy
Malaria - parasitology
Mefloquine
Plasmodium falciparum - drug effects
Quinine - therapeutic use
Quinolines - therapeutic use
Cameroon
Angola
Burkina Faso
Madagascar
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Summary:One thousand and twenty six P. falciparum strains isolated from cases imported in France and field surveys in four regions of Africa and Madagascar were studied in vitro against chloroquine, monodesethylamodiaquine, quinine and mefloquine, 917 in vivo tests were performed during field studies with chloroquine (10 and 25 mg/kg) and amodiaquine (10, 25, 35 mg/kg). In Madagascar, the chemoresistance remained low and stable during the study period, concerning mostly chloroquine (11% in vitro and in vivo) without obvious geographical variation. 25 mg/kg chloroquine or amodiaquine were satisfactory as respectively first and second line therapeutic regimen. In Central Africa, chemoresistance emerged with an epidemic profile and increased dramatically in disseminated urban focus. High level and prevalence of chloroquine resistance and multiresistance were observed few months after the index cases in these foci. In South West Cameroon, amodiaquine remained efficient as curative treatment but only at a dose of 35 mg/kg/5 days. Decrease of in vitro sensitivity and in vivo efficacy of quinine is a matter of concern. Given the heterogeneous and evolutive situation of drug resistance, the need for epidemiological surveillance and monitoring of P. falciparum drug sensitivity in Africa is obvious to adjust therapeutic regimen.