A questionnaire survey was performed among 550 acutely febrile patients with malaria to determine whether pruritus accompanied chloroquine therapy when the drug was employed to suppress paroxysmal febrile attacks. Eighty-one (74.3%) of the 109 respondents, including two Asian and one white patients, recalled the past occurrence of regular (60%) or occasional (40%) pruritus under those conditions, and 15 black patients (13.8%) under active treatment were currently experiencing itching. The typical pruritic reaction following chloroquine administration was generalized, began after a latency of 11 +/- 9 hours (mean +/- SD of 15 acute reactions), increased to a moderately severe peak of intensity within 25 +/- 12 hours, remained maximal for about 12 hours, and then gradually subsided completely 55 +/- 21 hours after onset. Antihistamines were largely ineffective for the relief of pruritus. These results suggest that certain undetermined factors, present in febrile patients with malaria, predispose to 4-aminoquinoline-induced pruritus. Black patients may have an increased susceptibility to this symptomatic drug reaction.
Bacl^round Limb activity meters are useful in correlation with subjective measurements for studying the antipruritic effects of drugs against current chloroquine itch among patients with malarial fever, in a tropical environment. Objective To prospectively monitor the palliative effects of drugs, without any presumptively significant antipuritic effects known, against moderate to severe chloroquine-related pruritus among patients with malaria. Methods Using a standard ordinal (0-10) scale questionnaire and limb activity meters on all limbs, 60 subjects (50 malarial patients plus 10 healthy controls; both sexes; aged 16-32 years) were recruited for study. Forty patients and the 10 healthy unmedicated controls completed the study and were used for data analysis. Results Dapsone (50 mg tablets, 8 hourly, orally) significantly reduced pruritus ordinal scores (below 2.5) and limb activity recordings to levels comparable with unmedicated controls by the second or third night of nocturnal monitoring the chloroquine itch among the patients. Clemastine or ketotifen (1 mg tablets, 8 hourly, orally) or prednisolone (5 mg tablets, 12 hourly, for 3 days, then tapered to 5 mg daily for another 2 days, orally), did not significantly exceed the placebo responsiveness to vitamin B-complex tablets (one 8 hourly, orally, for 3 days). Conclusion Dapsone, or sulphapyridine (500 mg tablets, 6 hourly, orally daily for 5 days in another recent investigation) have now emerged as potent symptomatic palliatives against chloroquine pruritus.
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