Dramatically decreased therapeutic efficacy of chloroquine and sulfadoxine-pyrimethamine, but not mefloquine, in southern Benin

Objective To evaluate the in vivo therapeutic efficacy of chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and mefloquine (MQ) in children presenting with uncomplicated malaria in Benin. Methods Drug efficacy was tested according to the WHO in vivo 28-day protocol. For failures that occurred after 7 days of follow-up, paired pre- and post-treatment blood samples were genotyped at msp1 and msp2 loci to distinguish new infections and recrudescent strains. Children enrolled were randomly assigned to a therapeutic group (CQ, n = 14; SP, n = 42; MQ, n = 44). The number of CQ treatment was intentionally restricted after 1 month, as its use was considered to constitute a danger for children. Results Chloroquine and SP showed very high failure rates (85.7% and 50%, respectively), whereas MQ treatment was successful in 97.5%. The molecular tool allowed to re-evaluate two new infections previously considered as failures. Conclusions Chloroquine should no longer be used to treat children presenting with Plasmodium falciparum malaria in Benin.