Brice B K, William Y, Lacina O, Félix Y, Hugues A, Léonardo B, André M, Joseph D
Université de Cocody (22 BP 582 Abidjan 22), Institut Pasteur (IPCI) de Côte d'Ivoire, 01 BP 490 Abidjan.
Tanzan J Health Res. 2010 Jan;12(1):73-9. doi: 10.4314/thrb.v12i1.56364.
Côte d'Ivoire is an endemic area for Plasmodium falciparum malaria, with perennial transmission in the southern forest and seasonal transmission in the northern savannah. Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT) is widespread in the country as elsewhere in Africa. The present study was conducted to assess the in vitro response of Plasmodium falciparum to antimalarial drugs currently used in the country (chloroquine, artemisinin and dihydroartemisinin) and new drugs that could be used in the near future (pyronaridine) and to analyse the pattern of cross-resistance between these drugs. The standard in vitro drug sensitivity microtechnique recommended by the World Health Organization was used to assess the sensitivity of Plasmodium falciparum isolates collected in Abidjan (Côte d'Ivoire) between April and December 2006. Of 128 in vitro tests performed, 112 (87.5%) were successful. Among them, 32, 27, 25, and 28 P. falciparum isolates grew satisfactorily and yield interpretable results for chloroquine, pyronaridine, artemisinin, and dihydroartemisinin respectively. The proportions of resistant isolates were 56.2% for chloroquine, 48% for pyronaridine, 36% for artemisinin and 3.6% for dihydroartemisinin. The most potent drug was dihydroartemisinin with a geometric mean IC50 of 2.72 nM ranged from 1.45 to 3.99 nM. No multi-resistant isolates (showing resistance to more than three drugs) were found. A positive correlation was found between the IC50 values for the following drugs: chloroquine and pyronaridine (r=0.45), pyronaridine and dihydroartemisinin (r=0.40), chloroquine and artemisinin (r=0.68), artemisinin and dihydroartemisinin (r=0.62). Data suggested cross-resistance between these drugs and warrant an improved surveillance programme for drug resistance to malaria in Côte d'Ivoire.
科特迪瓦是恶性疟原虫疟疾的流行地区，在南部森林地区常年传播，在北部大草原地区季节性传播。与非洲其他地方一样，该国将单纯性疟疾的一线治疗改为青蒿素联合疗法（ACT）的做法很普遍。本研究旨在评估恶性疟原虫对该国目前使用的抗疟药物（氯喹、青蒿素和双氢青蒿素）以及近期可能使用的新药（咯萘啶）的体外反应，并分析这些药物之间的交叉耐药模式。采用世界卫生组织推荐的标准体外药物敏感性微量技术，评估2006年4月至12月在阿比让（科特迪瓦）采集的恶性疟原虫分离株的敏感性。在进行的128次体外试验中，112次（87.5%）成功。其中，分别有32株、27株、25株和28株恶性疟原虫分离株对氯喹、咯萘啶、青蒿素和双氢青蒿素生长良好并产生可解释的结果。耐药分离株的比例分别为：氯喹56.2%，咯萘啶48%，青蒿素36%，双氢青蒿素3.6%。最有效的药物是双氢青蒿素，几何平均IC50为2.72 nM，范围为1.45至3.99 nM。未发现多重耐药分离株（对三种以上药物耐药）。发现以下药物的IC50值之间存在正相关：氯喹和咯萘啶（r = 0.45），咯萘啶和双氢青蒿素（r = 0.40），氯喹和青蒿素（r = 0.68），青蒿素和双氢青蒿素（r = 0.62）。数据表明这些药物之间存在交叉耐药，因此有必要改进科特迪瓦疟疾耐药性监测计划。
