Chimiorésistance de P. falciparum en milieu urbain à Yaoundé, Cameroun. Part 1: S urveillance in vitro et in vivo de la résistance de Plasmodium falciparumà la chloroquine entre 1994 et 1999 à Yaoundé, Cameroun

摘要: Resume La chloroquine reste le medicament de premiere intention dans la plupart des pays africains pour traitement l'acces palustre simple. Cependant, l'extension resistance Plasmodium falciparuma ce necessite une surveillance reguliere. Nous avons evalue 1994 a 1999, l'evolution chloroquino-resistance chez adultes (> 15 ans) et enfants (5–15 par tests d'efficacite therapeutique in vitro. Le test vivo ete effectue sur 14 jours les resultats ont exprimes selon nouveaux criteres l'Organisation Mondiale Sante. Les du semi-microtest microtest en concentration inhibitrice 50% (CI50) seuil est fixea CI50 > 100 nm. Sur l'ensemble l'etude, pourcentage d'echecs cliniques parasitologiques 39,7% (31,3% – 48,1%) 48,8% (40,2% – 57,4%), respectivement. Parallelement, vitro atteint 52,5% (48,1% – 56,9%) moyenne geometrique CI50 variait au cours suivi 84,6 nm 149,8 nm. sont concordants avec (coefficient kappa = 0,69). Ces etudes completees dosages chloroquinemie plasmas sujets J0, J3, J7 J14. permis mettre evidence variations inter-individuelles importantes concentrations moyennes superieures rapport aux demontre que certains acces palustres pouvaient etre lies insuffisantes chloroquine. confirment niveau eleve Yaounde suggerent l'utilisation d'un autre antipaludique simple. Summary Chloroquine is indicated for the first-line treatment of uncomplicated malaria most African countries. However, spread chloroquine-resistant falciparum requires periodic monitoring. Between and we studied evolution adults (aged > 15 years) children aged 5–15 years by using therapeutic efficacy assays. Responses to 14-day were classified according new criteria established World Health Organization. The results expressed as inhibitory (IC50), threshold level was set at IC50 > 100 nM. overall percentages clinical parasitological failures 39.7% (31.3% – 48.1%) 48.8% (40.2% – 57.4%), respectively. Similarly, percentage isolates that resistant 52.5%. During study, IC50 geometric mean varied between 84,6 nM 149,8 nM. assays agreed with those (kappa coefficient 0.69). patients' plasma levels measured on day 0, 3, 7, 14. Drug measurement showed wide inter-individual higher than children. Some cases failure associated inadequate Our confirm high suggest use an alternative antimalarial drug warranted.