RESPONSE OF UNCOMPLICATED FALCIPARUM-MALARIA TO ORAL CHLOROQUINE AND QUININE IN BURUNDI HIGHLANDS

The in vivo response of falciparum malaria to oral chloroquine and qui nine was evaluated in two identical hospital-based, comparative open t rials carried out 2 years apart in the same seasonal period at a hospi tal located in the highlands of Northern Burundi. Children aged 0-14 w ith uncomplicated falciparum malaria were administered either chloroqu ine, at 25 mg/kg over 3 days, or quinine, at 10 mg/kg per 8 hourly for 5 days (alternate allocation) and treatment response was evaluated by the WHO 7-day test. In the first study (1992/1993) 472 patients quali fied for analyses (211 in the chloroquine and 261 in the quinine group ), as compared to 249 subjects in the second study (1994/1995). In eac h study, the response to quinine was significantly higher than that to chloroquine (P = 0.004 and < 0.001, respectively). While the response to quinine showed insignificant changes over time (95.8 vs. 92.9%), c hloroquine was found to be significantly less effective in the second study as compared to the first (77.8 vs. 63.1%; OR (95% CI) 2.04 (1.21 -3.43)). Such decline in chloroquine efficacy was attributable to the age group < 5 years of age, where response to chloroquine decreased fr om 72.9% in 1992/93 to 56% in 1994/1995. Uncontrolled chloroquine use, which spread after the onset in late 1993 of the still ongoing ethnic fighting, appears to be the most likely reason for such a decrease in chloroquine efficacy. Chloroquine resistance has long been known to b e present in the hyperendemic lowlands of Burundi, but no data have so far been reported on the response to antimalarials in the highlands o f the country. These findings should be considered when deciding on dr ug policies for the treatment of falciparum malaria in Burundi. (C) 19 98 Elsevier Science B.V. All rights reserved.