A randomized clinical trial with high dose of chloroquine for treatment of Plasmodium falciparum malaria in Brazil

Andrade, João Carlos de; Andrade, Ana Fátima Souza Melo de; Araujo, Elisabeth S. O.; Oliveira, Renato Maurício de; Silva, S. A.; Martelli, Celina Maria Turchi; Zicker, Fabio

doi:10.1590/s0036-46651992000500015

Cited by 14 publications

(13 citation statements)

References 8 publications

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“…In accordance with this, only minimal side effects were found in previous studies using higher than recommended doses of chloroquine. 2,4,9 In the present study, no serious side effects were observed, although three children in the low-dose group complained of itching, two of them so severe that they refused to take the last tablets. On the day of enrollment, five children in the high-dose group received quinine intramuscularly due to vomiting compared with only one child in the low-dose group.…”

Section: Discussioncontrasting

confidence: 45%

“…This has previously been shown to be effective by resulting in higher cure rates than the standard dose of 25 mg/kg. [2][3][4]9 It is reasonable to believe that the effect of a higher chloroquine dose would not only prolong the time to recrudescence, but also to cure additional individuals with malaria.…”

Section: Discussionmentioning

confidence: 99%

“…Doses greater than the standard one have been shown to be more effective in areas with RI-RII resistance to chloroquine. [2][3][4] However, the efficacy of such doses and their possible adverse effects in Guinea-Bissau are not known. Therefore, we compared the outcome of therapy in children with symptomatic malaria given a total chloroquine dose of 25 mg base/kg as recommended by the WHO with a total dose of 50 mg/kg, which is closer to what is presently used in Guinea-Bissau.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of children with Plasmodium falciparum malaria with chloroquine in Guinea-Bissau.

Kofoed¹,

López²,

Johansson³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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Abstract. Children with symptomatic malaria in Bissau, Guinea-Bissau were randomly assigned to treatment with a 25 mg/kg total dose of chloroquine as recommended by the National Malaria Program or with a higher total dose of 50 mg/kg. Sixty-seven and 62 children, respectively, completed the treatment and were then followed once a week for five weeks. Treatment with a dose of 50 mg/kg was significantly more effective than treatment with 25 mg/kg in preventing recrudescence. The cumulative relative risk (95% confidence interval) of having parasitemia in the low-dose group during follow-up was 0.20 (0.08-0.52) on day 21, 0.38 (0.17-0.86) on day 28, and 0.48 (0.23-0.98) on day 35. Few adverse events were reported, although more children complained of vomiting and diarrhea on day 2 in the high-dose group compared with those in the low-dose group. However, this difference was not statistically significant. We conclude that a dose of 50 mg/kg of chloroquine could be recommended for treatment of Plasmodium falciparum malaria in Bissau. To minimize the risk of side effects, this higher dose should be given divided into two daily doses over a three-day period.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of children with Plasmodium falciparum malaria with chloroquine in Guinea-Bissau.

Kofoed¹,

López²,

Johansson³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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“…Study sites -At present, clinical failures of chloroquine are reaching 100% in many areas of Brazil, and the drug is no longer recommended for treatment of uncomplicated P. falciparum malaria (Andrade et al 1992). With the advent of chloroquine resistance, other antimalarials were introduced, most commonly PS.…”

Section: Methodsmentioning

confidence: 99%

Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase of isolates from the Amazon Region of Brazil

Vasconcelos

Plowe

Fontes

et al. 2000

Mem. Inst. Oswaldo Cruz

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Malaria is one of the major public health problems in Brazil, with 450,000 cases (about 77.2% Plasmodium vivax and 21.8% P. falciparum) and approximately 10,000 deaths reported annually (Marques 1995). The Amazon region, in which migrant populations, great distances, and poor access to diagnosis and treatment are the major obstacles to malaria control, accounts for more than 95% of the cases in Brazil (Marques 1993(Marques , 1995.Compounding the existing problem is the emergence and spread of P. falciparum resistant to chloroquine and pyrimethamine-sulfadoxine (PS; Fansidar TM Hoffman-LaRoche, Basel), which were + Corresponding

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“…2 Higher doses (50 mg base/kg) have been tested elsewhere but appear only to delay the onset of recrudescence. 3 In India, the selection of therapy for the treatment of acute, uncomplicated P. falciparum malaria is becoming more difficult due to the increasing resistance of the parasite to chloroquine. 4 CGP 56697 (co-artemether) is an oral, fixed-dose combination of artemether, a derivative of artemisinin, and lumefantrine (benflumetol), a molecule developed by the Academy of Military Medical Sciences in Beijing, People's Republic of China.…”

Section: Introductionmentioning

confidence: 99%

A randomized, double-blind, parallel-group, comparative safety, and efficacy trial of oral co-artemether versus oral chloroquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in India.

Kshirsagar¹,

Gogtay²,

Moorthy³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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Abstract. In India, treatment of acute, uncomplicated Plasmodium falciparum malaria is becoming increasingly difficult due to resistance to chloroquine, thus there is a need for new antimalarial drugs. CGP 56697 (co-artemether), a new drug, is a combination of artemether and lumefantrine in a single oral formulation (one tablet ϭ 20 mg of artemether plus 120 mg of lumefantrine). In a double-blind study, 179 patients with acute uncomplicated P. falciparum malaria were randomly assigned to receive either CGP (n ϭ 89) given as a short course of 4 ϫ 4 tablets over a 48-hr period or chloroquine (n ϭ 90) given as four tablets (one tablet ϭ 150 mg of chloroquine base) initially, followed by two tablets each at 6-8, 24, and 48 hr. Due to a death in the chloroquine group and a decrease in the chloroquine cure rate to Ͻ 50% (based on the blinded overall cure rate at that time), recruitment was terminated prematurely. CGP 56697 showed a superior 28-day cure rate (95.4% versus 19.7%; P Ͻ 0.001), time to parasite clearance (median ϭ 36 versus 60 hr; P Ͻ 0.001), and resolution of fever (median ϭ 18 versus 27 hr; P ϭ 0.0456). This drug provides a safe, effective, and rapid therapy for the treatment of acute uncomplicated P. falciparum malaria.

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A randomized clinical trial with high dose of chloroquine for treatment of Plasmodium falciparum malaria in Brazil

Cited by 14 publications

References 8 publications

Treatment of children with Plasmodium falciparum malaria with chloroquine in Guinea-Bissau.

Treatment of children with Plasmodium falciparum malaria with chloroquine in Guinea-Bissau.

Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase of isolates from the Amazon Region of Brazil

A randomized, double-blind, parallel-group, comparative safety, and efficacy trial of oral co-artemether versus oral chloroquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in adults in India.

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