In Ghana in 2004 (when choroquine was still the nationally recommended
drug for the first-line treatment of
malaria), the sensitivities, to
chloroquine,
amodiaquine,
quinine,
mefloquine,
artesunate and
halofantrine, of 60 Plasmodium falciparum isolates from two ecologically distinct areas of the country were assessed in vitro. The aim was to make available, to policy-makers, the field-based evidence needed to review the national strategy for
malaria treatment.
Drug susceptibilities were explored using the standardized protocol of the
Antimalarial Drug Resistance Network. Although 32 of the P. falciparum isolates evaluated (56.1% of the 57 isolates successfully investigated for their susceptibility to choroquine) showed resistance to
chloroquine and two showed slightly reduced sensitivity to
amodiaquine, all the isolates were sensitive to
mefloquine,
artesunate,
quinine and
halofantrine. The median inhibitory concentrations (IC(50)) of
chloroquine were positively correlated with those of
quinine (r=0.4528; P=0.0008) but not those of any of the other drugs investigated. The IC(50) of
amodiaquine and
artesunate were also positively correlated (r=0.3703; P=0.0067). These results provide evidence of the presence, in Ghana, of P. falciparum isolates that are highly resistant to
chloroquine but generally sensitive to most of the other
antimalarial drugs commonly used in the country. Partly in consequence of these observations, the recommended first-line treatment for
malaria in Ghana was changed to an
amodiaquine-artesunate combination in January 2005.