Hindawi Publishing Corporation Malaria Research and Treatment Volume 2013, Article ID 234683, 10 pages http://dx.doi.org/10.1155/2013/234683 Clinical Study Amodiaquine-Artesunate versus Artemether-Lumefantrine against Uncomplicated Malaria in Children Less Than 14 Years in Ngaoundere, North Cameroon: Efficacy, Safety, and Baseline Drug Resistant Mutations in pfcrt, pfmdr1, and pfdhfr Genes Innocent M. Ali, 1,2 Palmer M. Netongo, 1 Barbara Atogho-Tiedeu, 1 Eric-Olivier Ngongang, 1,3 Anthony Ajua, 1,4 Eric A. Achidi, 4 and Wilfred F. Mbacham 1 1 Laboratory for Public Health Research Biotechnologies, University of Yaounde, BP 8094, Yaounde, Centre Region, Cameroon 2 Department of Biochemistry, University of Dschang, BP 67, Dschang, West Region, Cameroon 3 Universite des Montagnes, BP 208, Bangante, West Region, Cameroon 4 Faculty of Science, University of Buea, BP 63, Buea, South West Region, Cameroon Correspondence should be addressed to Wilfred F. Mbacham; wfmbacham@yahoo.com Received 30 June 2013; Revised 15 October 2013; Accepted 29 October 2013 Academic Editor: Polrat Wilairatana Copyright © 2013 Innocent M. Ali et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. In Cameroon, both Artesunate-amodiaquine (AS/AQ) and artemether-lumefantrine (AL) are used as irst-line treatment against uncomplicated malaria in line with the WHO recommendations. We compared the eicacy and safety of both therapeutic combinations and determined the prevalence of drug resistance conferring mutations in three parasite genes. Methods. One hundred and ity acute malaria patients between six months and 14 years of age were randomized to receive standard doses of either AS/AQ (73) or AL (77) and followedup for 28 days. Outcome of treatment was according to the standard WHO classiication. DNA samples from pretreatment parasite isolates were used to determine the prevalence of resistant mutations in the pfcrt, pfmdr1, and dhfr genes. Results. Both drug combinations induced rapid clearance of parasites and malaria symptoms. PCR-corrected cure rates were 100% and 96.4% for AL. he combinations were well tolerated. Major haplotypes included CVIET (71%), CVMNT (25%) for the pfcrt; SND (100%) for the pfmdr1; IRN (79, 8%), NCS (8.8%), and mixed haplotype (11, 8%) for the dhfr. Conclusion. Both AS/AQ and AL were highly efective and well tolerated for the treatment of uncomplicated falciparum malaria in Ngaoundere, Cameroon. High prevalence of mutant pfcrt alleles conirms earlier observations. Long-term monitoring of safety and eicacy and molecular markers is highly solicited. 1. Introduction Malaria remains one of the most serious health problems worldwide and a leading cause of childhood morbidity and mortality in Africa [1]. Early diagnosis and prompt efective treatment remains the cornerstone for the reduction of malaria-related morbidity and mortality [2]. he control of malaria has been challenged by increasing resistance of Plasmodium falciparum to antimalarial drugs, particularly chloroquine (CQ) and sulfadoxine-pyrimethamine (SP), leading to sweeping changes in antimalarial treatment recom- mendations [3]. However, the decision to change antimalarial treatment guidelines is complex. his is limited by the ready availability of alternatives with proven clinical eicacy, pro- curement and supply costs, and likely durability of the new policy. he latter is largely determined by the rate at which resistance to the irst-line drugs develops, itself a function of the mechanisms of resistance to the antimalarial. Across Africa, P. falciparum resistance to the inexpensive and widely used drugs has reached very high levels, and noticeably hampered malaria control eforts in the region [3–5]. As a consequence, the use of combination therapy against malaria has been widely advocated and now imple- mented in a majority of endemic African countries [6]. Com- bination regimens, including a number of artemisinin-based