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Malaria Journal
Published in: Malaria Journal 1/2016

Open Access 01-12-2016 | Research

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

Authors: Ahmed A. Adeel, Fahad Awad Ali Elnour, Khalid Abdalmutalab Elmardi, Mona B. Abd-Elmajid, Mai Mahmoud Elhelo, Mousab S. Ali, Mariam A. Adam, Hoda Atta, Ghasem Zamani, Marian Warsame, Amy Barrette, Hanan El Mohammady, Rania A. Nada

Published in: Malaria Journal | Issue 1/2016

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Abstract

Background

The 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.

Methods

The 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.

Results

In 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.

Conclusion

The 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 Registry

Trial registration numbers 2011–2012: ACTRN12611001253998, 2013–2015: ACTRN12613000945729
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Metadata
Title
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
Authors
Ahmed A. Adeel
Fahad Awad Ali Elnour
Khalid Abdalmutalab Elmardi
Mona B. Abd-Elmajid
Mai Mahmoud Elhelo
Mousab S. Ali
Mariam A. Adam
Hoda Atta
Ghasem Zamani
Marian Warsame
Amy Barrette
Hanan El Mohammady
Rania A. Nada
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2016
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/s12936-016-1339-x

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