The efficacy of chloroquine, sulfadoxine–pyrimethamine and a combination of both for the treatment of uncomplicated Plasmodium falciparum malaria in an area of low transmission in western Uganda

Abstract

SummaryWe conducted an efficacy study of chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and a combination of both (SP + CQ) for the treatment of uncomplicated malaria in an area of low transmission with low drug pressure. On day 3, fever clearance was 97.4% (95% CI, 86.8-99.9), 100% (95% CI, 87.2-100) and 96.6% (95% CI, 82.2-99.9) in the CQ, SP and SP + CQ groups, respectively, (P ¼ 0.65). On day 14, clinical success was 92.5% (95% CI, 79.6-98.4), 100% (95% CI, 87.2-100) and 100% (95% CI, 88.1-100) in the CQ, SP and CQ + SP groups, respectively. Clinical failure was seen in 7.5% with 5% (95% CI, 0.61-16.9) early treatment failure and 2.5% (95% CI, 0.06-13.2) late treatment failure of cases in the CQ group and 0% in the SP and SP + CQ groups. Parasitological resistance was observed at RI level in 10% (95% CI, 2.8-23.7), 18.5% (95% CI, 6.3-38.1) and 6.9% (95% CI, 0.85-22.8) for the CQ, SP and SP + CQ, respectively (P ¼ 0.37). There was no age-dependent difference in clinical failure or parasitological resistance in any of the treatment groups and prior CQ use within the last 2 weeks did not affect CQ treatment outcome. The findings of this study suggest that CQ is still effective for the treatment of uncomplicated malaria in this area of low transmission and SP. However, combination therapy of SP + CQ is recommended to delay the development SP resistance, and regular surveillance for emerging CQ and SP resistance is needed to plan for alternative antimalarial drug regimens.

Trends in malaria-attributable morbidity and mortality among young children admitted to Ugandan hospitals, for the period 1990–2001

“…These increases mean that temperatures at Kabale are now more conducive to mosquito survival and parasite development in the vectors than they were in the past and that, in consequence, the intensity of transmission has probably increased. Since CQ and SP are still effective against P. falciparum in the area (Ndyomugyenyi et al, 2004), there is no indication that the increase in the numbers of malaria cases is the result of drug resistance. Temperature is a major determinant of mosquito survival, and there is a complex temperature-related interplay, between mosquito survival and the development of the malarial parasite, that affects both the probability and the intensity of transmission (Beier, 1998).…”

“…Malaria transmission is unstable and usually occurs in epidemics associated with high levels of morbidity and mortality. A study in 2001 revealed little evidence of drug resistance to either SP or CQ, the standard doses of these drugs clearing 82% and 90% of parasitaemias and giving clinical cure in 100% and 97% of cases, respectively (Ndyomugyenyi et al, 2004). The frequency of bednet use in the area, about 10% (unpubl.…”

“…The main aim of the present, retrospective study, which was based on reviews of hospital records, was to determine the temporal trends in malaria-related morbidity and mortality among Ugandan children aged <5 years. The two study sites differed in their levels of malaria transmission and in the levels of drug resistance in the local P. falciparum (Ndyomugyenyi and Magnussen, 1997;Ndyomugyenyi et al, 2004).…”

Community effectiveness of malaria treatment in Uganda—a long way to Abuja targets

“…The sixth element, drug efficacy, was estimated from other studies. 28,29 Treatment of febrile children. Of the 260 children who had had fever in the previous 2 weeks, caregivers reported different treatment actions being taken for 224 children (87%).…”

Short course of quinine plus a single dose of sulfadoxine/pyrimethamine for Plasmodium falciparum malaria

“…Combination therapy which may delay the spread of drug resistance in addition to increasing efficacy is another concept which has been introduced in the fight against malaria. In several studies, antimalarial drugs (chloroquine, SP, amodiaquine, artesunate and atovaquone-proguanil) have been used in various combinations in order to increase efficacy, prevent the development of resistance and reduce transmission by decreasing gametocytemia induction [8][9][10][11][12][13][14][15].…”