Beyond Chloroquine: Implications of Drug Resistance for Evaluating Malaria Therapy Efficacy and Treatment Policy in Africa

Emphasis on retaining chloroquine as the first-line therapy for Plasmodium falciparum infections in most of sub-Saharan Africa for as long as it remains effective has resulted in widespread reliance on chloroquine in areas where it can have little effect on P. falciparum parasitemia. To address this...

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Bibliographic Details
Published in:The Journal of infectious diseases 1993-04, Vol.167 (4), p.932-937
Main Authors: Bloland, Peter B., Lackritz, Eve M., Kazembe, Peter N., Were, Joab B. O., Steketee, Richard, Campbell, Carlos C.
Format: Article
Language:English
Subjects:
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials
Antiparasitic agents
Biological and medical sciences
Blood
Child, Preschool
Children
Chloroquine - therapeutic use
Drug Combinations
Drug Resistance
Female
Fever
Follow-Up Studies
Hemoglobin A - metabolism
Hemoglobins
Humans
Infant
Infections
Kenya
Major Articles
Malaria
Malaria, Falciparum - blood
Malaria, Falciparum - drug therapy
Malaria, Falciparum - parasitology
Malawi
Male
Medical sciences
Parasitemia
Parasites
Parasitism
Pharmacology. Drug treatments
Pyrimethamine - therapeutic use
Sulfadoxine - therapeutic use
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Summary:Emphasis on retaining chloroquine as the first-line therapy for Plasmodium falciparum infections in most of sub-Saharan Africa for as long as it remains effective has resulted in widespread reliance on chloroquine in areas where it can have little effect on P. falciparum parasitemia. To address this issue, clinical, parasitologic, and hematologic responses to chloroquine or pyrimethamine/sulfadoxine treatment were assessed among very young children in Malawi (n = 153) and Kenya (n = 73). The median time to resumption of clinical symptoms in chloroquine-treated children was 13.5 days in Malawi and 9.5 days in Kenya. Children treated with pyrimethamine/sulfadoxine maintained clinical improvement and had greater increases in their hemoglobin concentration during the follow-up period than did children treated with chloroquine. Treatment with chloroquine failed to produce either a durable clinical improvement or optimal hematologic recovery. Consequently, chloroquine can no longer be considered adequately effective therapy of clinical P. falciparum malaria in very young children in these areas of Africa.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/167.4.932