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Malaria prophylaxis with proguanil in children living in a malaria-endemic area
N Limsomwong1, L W Pang, P Singharaj
1U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand.
Insights
Daily proguanil and weekly chloroquine showed similar efficacy for malaria prevention in children. Proguanil had more vivax malaria failures, but both treatments were well-tolerated.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Pharmacology
Background:
- Malaria remains a significant public health concern in endemic regions.
- Effective malaria prophylaxis is crucial for protecting vulnerable populations, especially children.
- Evaluating different antimalarial drug regimens is essential for optimizing prevention strategies.
Purpose of the Study:
- To compare the efficacy and safety of daily proguanil versus weekly chloroquine for malaria prophylaxis in children.
- To assess the prophylactic effects against Plasmodium falciparum and Plasmodium vivax malaria.
- To determine the incidence of malaria infections and treatment-related side effects in both groups.
Main Methods:
- A randomized controlled trial involving 170 children aged 5-10 years in a malaria-endemic area.
- Children were matched and randomly assigned to receive either daily proguanil or weekly chloroquine.
- Weekly malaria smears and monitoring for side effects were conducted throughout the study period.
Main Results:
- No statistically significant difference in Plasmodium falciparum malaria prophylaxis between daily proguanil and weekly chloroquine.
- Proguanil showed potential causal prophylactic effects against Plasmodium falciparum.
- Significantly higher rates of Plasmodium vivax prophylactic failures were observed in the proguanil group (P < 0.01).
- Adverse events were infrequent, mild, and comparable between the two treatment groups.
Conclusions:
- Both daily proguanil and weekly chloroquine demonstrate comparable efficacy for Plasmodium falciparum malaria prophylaxis.
- Daily proguanil may offer some causal prophylactic benefit against Plasmodium falciparum.
- Weekly chloroquine appears more effective in preventing Plasmodium vivax malaria breakthrough infections.
- Both regimens are generally well-tolerated in pediatric populations.
Abstract:
We studied the effects of daily proguanil compared to weekly chloroquine as malaria prophylaxis in 170 children living in a malaria-endemic area along the Thai-Burmese border. Children aged 5-10 years were matched for age, weight, and presence of splenomegaly then randomly assigned to receive either proguanil (equivalent of 200 mg daily adult dose) or chloroquine (equivalent of 300 mg base weekly). All medications were administered by the investigators and malaria smears were performed on a weekly basis. Among 85 children taking proguanil for 524 human-weeks, there were 17 cases of falciparum malaria and 11 cases of vivax. Of 85 children on chloroquine for 537 human-weeks, there were 24 cases of falciparum and 1 case of vivax. There were no statistically significant differences between the two regimens when analyzed either as suppressive or as causal Plasmodium falciparum prophylactics. The data were suggestive that proguanil may have some causal prophylactic effect against falciparum malaria. There were significantly more vivax prophylactic failures (P less than 0.01) in the proguanil group. Side effects were infrequent, mild, and comparable in both groups.