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Proguanil-sulphonamide for malaria prophylaxis.

J J Karwacki1, G D Shanks, N Limsomwong

  • 1Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.

Transactions of the Royal Society of Tropical Medicine and Hygiene
|January 1, 1990
PubMed
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Proguanil and sulphonamide combinations show over 75% efficacy in preventing malaria in children. This combination is a potential alternative for malaria chemoprophylaxis, especially against drug-resistant Plasmodium falciparum.

Area of Science:

  • Tropical Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Limited availability of safe and effective malaria chemoprophylaxis, particularly for Plasmodium falciparum in Southeast Asia.
  • Need for alternative antimalarial regimens due to increasing drug resistance.

Purpose of the Study:

  • To evaluate the chemoprophylactic efficacy of combined proguanil and sulphonamide treatments against malaria in schoolchildren.
  • To assess the safety and effectiveness of different dosages of sulphonamide in combination with proguanil.

Main Methods:

  • Two randomized, placebo-controlled trials involving schoolchildren aged 6-15 years near the Thai-Burmese border.
  • Testing daily combinations of proguanil (200 mg/d) with sulphafurazole (25 mg/kg/d) or sulphamethoxazole (25 mg/kg/d and 10 mg/kg/d).

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Main Results:

  • Proguanil combined with either sulphafurazole or sulphamethoxazole at 25 mg/kg/d demonstrated over 75% efficacy against both Plasmodium falciparum and Plasmodium vivax malaria.
  • A lower dose of sulphamethoxazole (10 mg/kg/d) in combination with proguanil was ineffective.
  • A low incidence (approximately 1%) of self-resolving sulphonamide-related skin rashes was observed.

Conclusions:

  • Daily proguanil/sulphonamide combinations, specifically at a 25 mg/kg/d sulphonamide dose, are effective and safe for malaria chemoprophylaxis in children.
  • This regimen represents a viable alternative for malaria prevention in regions with multidrug-resistant Plasmodium falciparum strains.