High efficacy of artemether-lumefantrine and declining efficacy of artesunate + sulfadoxine-pyrimethamine against Plasmodium falciparum in Sudan (2010–2015): evidence from in vivo and molecular marker studies

Malaria Journal

Research

Ahmed A. Adeel¹  Amy Barrette²  Marian Warsame²  Ghasem Zamani³  Hoda Atta³  Fahad Awad Ali Elnour⁴  Mariam A. Adam⁴  Mona B. Abd-Elmajid⁴  Mai Mahmoud Elhelo⁴  Khalid Abdalmutalab Elmardi⁴  Mousab S. Ali⁴  Hanan El Mohammady⁵  Rania A. Nada⁵ 

[1] College of Medicine, King Saud University, Riyadh, Saudi Arabia;Global Malaria Programme, World Health Organization, Geneva, Switzerland;Malaria Control and Elimination, Division of Communicable Diseases Control, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt;National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan;Naval Medical Research Unit-3, Cairo, Egypt;

关键词: Sudan;    Sulfadoxine-pyrimethamine;    Artesunate;    Artemether-lumefantrine antimalarial drugs;    Drug resistance;    Molecular markers;    dhfr;    dhps;   

DOI  :  10.1186/s12936-016-1339-x

 received in 2016-01-24, accepted in 2016-05-11,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe present paper reports on studies that evaluated artesunate + sulfadoxine-pyrimethamine (AS + SP) which is the first-line drug and artemether-lumefantrine (AL) which is a second-line drug against uncomplicated falciparum malaria in Sudan. This evaluation was performed in twenty studies covering six sentinel sites during five successive annual malaria transmission seasons from 2010 to 2015.MethodsThe standard World Health Organization protocol was used for a follow-up period of 28 days. The frequency distribution of molecular markers for antifolate resistance in dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes was studied in pre-treatment samples in four sites in 2011.ResultsIn the nine studies of AL conducted at five sites (n = 595), high PCR-corrected cure rates were found, ranging from 96.8 to 100 %. Among the eleven studies of AS + SP (n = 1013), a decline in the PCR-corrected cure rates was observed in Gedaref in Eastern Sudan: 91.0 % in the 2011–12 season and 86.5 % in the 2014–15 season. In the remaining sites, the AS + SP cure rates ranged between 95.6 and 100 %. The rate of clearance of microscopic gametocytaemia after treatment was not significantly different with AL or AS + SP on days 7, 14, 21 and 28 of follow-up. A total of 371 pre-treatment samples were analysed for molecular markers of SP resistance. The temporal changes and geographical differences in the frequency distribution of SP-resistance genotypes showed evidence of regional differentiation and selection of resistant strains.ConclusionThe findings of this study call for a need to review the Sudan malaria treatment policy. Epidemiological factors could play a major role in the emergence of drug-resistant malaria in eastern Sudan.Australian New Zealand Clinical Trials RegistryTrial registration numbers 2011–2012: ACTRN12611001253998, 2013–2015: ACTRN12613000945729

【 授权许可】

CC BY   
© The Author(s). 2016