Anti-Malarial Drug Resistance in Cameroon
Condition: Malaria
MeSH terms: Malaria
Study type: Interventional
Phase: Phase 2/Phase 3

Summary: 
      The project is a three-armed study designed to evaluate the efficacy of amodiaquine(AQ),
      sulphadoxine-pyrimethamine(SP) and(AQ+SP) in three sites in Cameroon that differ in their
      baseline characteristics for malaria. In addition, drug resistance will be determined by
      measurement of blood drug levels,and identification of molecular markers of resistance.
    

Detailed description: 
      The objectives of this study are:- .

        -  to evaluate the therapeutic efficacy of amodiaquine(AQ), Fansidar(SP) and the
           combination amodiaquine/Fansidar in three sites in Cameroon namely, Garoua
           (Sahel-savanna), Yaounde (Forest-savannah mosaic) and Limbe (Littoral-forest)

        -  to determine the prevalence of molecular markers associated with resistance to
           chloroquine,AQ,and SP in Limbe and Garoua and of mefloquine in Yaounde.

        -  to investigate biological factors that may enhance anti-malaria therapeutic efficacy.
           This will involve an exploratory, pilot study conducted during the second year of the
           program.

      Patients will be rapidly screened for temperature and sent to the laboratory to determine the
      presence or absence of malaria parasites. The patients will then be examined clinically for
      inclusion or exclusion. Consent will be sort from the parents and the children randomised and
      assigned study numbers. To avoid bias in assigning the patients to groups and to ensure equal
      numbers in the treatment groups, blocked randomization will be performed, using a table of
      random variables of varying block sizes. The physician is blinded to what treatment the
      patient gets.

      Amodiaquine will be administered at 10mg/kg on each of the three days to children in the AQ
      treatment group, together with Fansidar dummy tablets. Fansidar will be given at 25 mg/kg on
      day 0 and quinine as rescue drug at 10mg/kg per 8H for 6 days. For the AQ/SP combination, on
      D0, patients will be given both 25 mg/kg SP and 10mg/kg AQ. On subsequent days the AQ or its
      dummy tablets(SP arm) will be given.

      Clinical assessment during the study will include: physical examination and monitoring of
      vital signs on D0, D3, D7, D14 and D28. Hematological measurements will include: blood films,
      haemoglobin,glucose,blood drug levels,and baseline haematology. A maximum of 3ml of blood
      will be withdrawn from the patients in Yaoundé for complete analyses(see below). For patients
      recruited at Limbe and Garoua only finger prick blood filter paper samples will be obtained.

      Day 0 blood samples (3mL) will be collected aseptically by venepuncture before therapy from
      each of 50 patients in Yaoundé using acid-citrate-dextrose buffer (ACD) as anticoagulant.
      This will be processed to provide plasma for immunological determinations and for haematology
      and blood drug level determinations.

      The molecular characterization of diversity and mutations:

        -  the genetic heterogeneity of the study population will be established using primers for
           msp1 and msp2 shown previously to distinguish between strains.

        -  PCR products will be digested with restriction enzyme (RFLP-PCR) for pyrimethamine
           resistance genes dhfr and dhps, and for chloroquine resistant strains of the pfcrtgene.
    

Intervention name(s): Amodiaquine and Sulphadoxine/Pyrimethamine
Intervention type(s): Drug
Intervention MeSH terms: Pyrimethamine; Sulfadoxine; Amodiaquine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double
Primary purpose: Treatment
Keywords: malaria; drug resistance; antimalarials