Formulation of malaria treatment policy for children in Côte d'Ivoire as chloroquine resistant Plasmodium falciparum spreads into West Africa

Abstract

To develop a malaria treatment policy for children with Plasmodium falciparum, an in vivo and in vitro chloroquine (CQ) sensitivity study was conducted in Côte d'Ivoire in September 1986. The efficacy of a single dose of CQ, (10 mg base kg⁻¹, C10) was tested with assessment of subjects on Days 2 and 7 after treatment; 108 (99%) of 109 children were aparasitaemic on Day 7. Of 33 isolates of P. falciparum tested in vitro, two (6%) were resistant to CQ. Although C10 appeared effective clinically and parasitologically in Côte d'Ivoire, a treatment dose of 25 mg of CQ.base kg⁻¹ (C25), over three days, was recommended as first-line therapy for malaria. This was because in vivo CQ-resistance will soon spread into other West African countries including Côte d'Ivoire, the C25 dose still retains clinical effectiveness in most partially-immune persons living in areas with low-level chloroquine resistance, and alternate drugs are more expensive.