Efficacy and tolerability of a low-dose mefloquine-sulfadoxine-pyrimethamine combination compared with chloroquine in the treatment of acute malaria infection in a population with multiple drug-resistant Plasmodium falciparum.

Abstract

The efficacy and tolerability of single, low-dose mefloquine, sulfadoxine-pyrimethamine (MSP) combination was compared with chloroquine (CQ) for malaria treatment in a malaria-endemic area of Nigeria with multiple drug-resistant Plasmodium falciparum. The two drug regimens (MSP and CQ) were tested in a 12-month prospective population study. The patients were divided into two groups. Group 1 patients were treated presumptively, based on malaria symptoms. Group 2 patients were treated based on a parasitologic diagnosis using the World Health Organization seven-day in vivo test and extended to a 28-day follow-up period. Tolerability was assessed by the incidence and intensity of adverse events. One thousand nine hundred thirty-five patients visiting 10 health facilities, including the University of Calabar Teaching Hospital, were enrolled. The study showed that the low-dose MSP was efficacious, with day 7 response rates of 95% and 91% for (presumptive) Group 1 and (in vivo) Group 2, respectively, while CQ had day 7 response rates of 82% and 66% in Groups 1 and 2, respectively. The low-dose MSP was significantly (P < 0.0001) more efficacious, with faster fever and parasite clearance times than CQ in this area of CQ-resistant P. falciparum malaria. Eight patients treated with CQ, including seven severe cases (RII-RIII) were successfully re-treated with MSP. Adverse events were generally more common among those treated with MSP (29%) than those treated with CQ (17%). However, the adverse events caused by both drugs were mild to moderate and self-limited. The MSP combination appears to be a good substitute for CQ, in view of multiple drug resistance, especially in areas with severe (RII-RIII) malaria.

• Authors: E N Ezedinachi, O J Ekanem, C M Chukwuani, M M Meremikwu, E A Ojar, A A Alaribe, A B Umotong, L Haller
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 61 Issue 1 Pg. 114-9 (Jul 1999) ISSN: 0002-9637 [Print] United States
• PMID: 10432067 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Drug Combinations
• mefloquine-sulfadoxine-pyrimethamine
• Sulfadoxine
• Chloroquine
• Mefloquine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Animals
• Antimalarials (administration & dosage, adverse effects, standards, therapeutic use)
• Blood (parasitology)
• Child
• Child, Preschool
• Chloroquine (administration & dosage, adverse effects, standards, therapeutic use)
• Drug Combinations
• Drug Resistance, Multiple
• Female
• Humans
• Infant
• Malaria, Falciparum (drug therapy)
• Male
• Mefloquine (administration & dosage, adverse effects, analogs & derivatives, standards, therapeutic use)
• Middle Aged
• Nigeria
• Plasmodium falciparum (drug effects)
• Prospective Studies
• Pyrimethamine (administration & dosage, adverse effects, standards, therapeutic use)
• Random Allocation
• Sulfadoxine (administration & dosage, adverse effects, standards, therapeutic use)