Kamya, Moses R.
(Address for correspondence: Moses R. Kamya, Department of Medicine, Makerere University, P.O. Box 7072, Kampala, Uganda)
,
Dorsey, Grant
(phone +256 041 541188)
,
Gasasira, Anne
(fax +256 041 533531.)
,
Ndeezi, Grace
(Department of Medicine, San Francisco General Hospital and The University of California, San Francisco, USA)
,
Babirye, Juliet N.
(Makerere University Medical School, Kampala, Uganda)
,
Staedke, Sarah G.
(Makerere University Medical School, Kampala, Uganda)
,
Rosenthal, Philip J.
(Makerere University Medical School, Kampala, Uganda)
AbstractChloroquine (CQ) remains the first-line treatment for uncomplicated malaria in much of Africa despite the growing problem of resistance to this drug. Sulfadoxine-pyrimethamine (SP) is often used after CQ treatment failure and has replaced CQ as the first-line treatment in parts of Africa. To...
AbstractChloroquine (CQ) remains the first-line treatment for uncomplicated malaria in much of Africa despite the growing problem of resistance to this drug. Sulfadoxine-pyrimethamine (SP) is often used after CQ treatment failure and has replaced CQ as the first-line treatment in parts of Africa. To compare the efficacy of these 2 regimens, we evaluated, in March–August 1999, clinical and parasitological responses over 28 days in 214 children and adults from Kampala, Uganda, with uncomplicated falciparum malaria. Compared to SP, significantly more patients treated with CQ developed early or late clinical failure (54% vs 11 % P < 0 · 001) and parasitological failure (72% ys 30%, P < 0 · 001) during 14 days of follow-up. The risk of treatment failure occurring after day 14 was similar between the 2 treatment groups. Among those treated with CQ, children aged <5 years were at higher risk of clinical failure than older individuals (76% vs 28%, P < 0 · 001), an association not seen with SP (11% vs 10%, P = 0 · 91). Although early parasite clearance was significantly better in the SP group (P = 0 · 001), fever clearance at day 3 was the same (CQ 85%, SP 86%). These and other recent findings suggest that consideration be given to replacing CQ as the first-line therapy for uncomplicated malaria in Uganda, particularly in young children.
AbstractChloroquine (CQ) remains the first-line treatment for uncomplicated malaria in much of Africa despite the growing problem of resistance to this drug. Sulfadoxine-pyrimethamine (SP) is often used after CQ treatment failure and has replaced CQ as the first-line treatment in parts of Africa. To compare the efficacy of these 2 regimens, we evaluated, in March–August 1999, clinical and parasitological responses over 28 days in 214 children and adults from Kampala, Uganda, with uncomplicated falciparum malaria. Compared to SP, significantly more patients treated with CQ developed early or late clinical failure (54% vs 11 % P < 0 · 001) and parasitological failure (72% ys 30%, P < 0 · 001) during 14 days of follow-up. The risk of treatment failure occurring after day 14 was similar between the 2 treatment groups. Among those treated with CQ, children aged <5 years were at higher risk of clinical failure than older individuals (76% vs 28%, P < 0 · 001), an association not seen with SP (11% vs 10%, P = 0 · 91). Although early parasite clearance was significantly better in the SP group (P = 0 · 001), fever clearance at day 3 was the same (CQ 85%, SP 86%). These and other recent findings suggest that consideration be given to replacing CQ as the first-line therapy for uncomplicated malaria in Uganda, particularly in young children.
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