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Sulfadoxine-pyrimethamine resistant falciparum malaria in Thai children
Insights
This study evaluated sulfadoxine-pyrimethamine regimens for treating uncomplicated falciparum malaria in children. A combination of quinine with sulfadoxine-pyrimethamine demonstrated the highest cure rates, suggesting its effectiveness.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Pharmacology
Background:
- Uncomplicated falciparum malaria poses a significant health burden in children.
- Evaluating effective antimalarial drug regimens is crucial for disease control.
- Sulfadoxine-pyrimethamine is a common treatment, but resistance is a concern.
Purpose of the Study:
- To compare the efficacy of different sulfadoxine-pyrimethamine dosages and a quinine combination regimen for treating uncomplicated falciparum malaria in children.
- To assess treatment outcomes based on cure rates and failure classifications (RI, RII, RIII).
Main Methods:
- A randomized trial involving 68 children with uncomplicated falciparum malaria.
- Three treatment groups received different regimens: single-dose sulfadoxine-pyrimethamine at varying doses, or a 5-day course of quinine combined with a single dose of sulfadoxine-pyrimethamine.
- Treatment outcomes were assessed based on parasitological cure and failure categories.
Main Results:
- The single-dose sulfadoxine-pyrimethamine regimens showed low cure rates and high failure rates (RI, RII, RIII).
- Group 1 (27 children): 7.4% cured, significant failure rates.
- Group 2 (18 children): 11.1% cured, high failure rates.
- Group 3 (23 children): 56.5% cured with quinine plus sulfadoxine-pyrimethamine, with 43.5% showing RI failure.
Conclusions:
- Standard single-dose sulfadoxine-pyrimethamine regimens were largely ineffective against uncomplicated falciparum malaria in this study population.
- Combining quinine with a single dose of sulfadoxine-pyrimethamine significantly improved cure rates compared to single-drug regimens.
- Further investigation into optimal antimalarial strategies for falciparum malaria in children is warranted.
Abstract:
Sixty-eight children with uncomplicated falciparum malaria admitted to the Hospital for Tropical Diseases in Bangkok during April-December 1980 were randomly divided into 3 groups and given 3 regimens. Group 1 of 27 cases were treated with a single dose of sulfadoxine 20 mg per kg body wt and pyrimethamine 1.0 mg per kg body wt. Two cases (7.4%) were cured (S) while 4 cases (14.8%) showed RI failure, 17 cases (63.0%) RII failure and 4 cases (14.8) RIII failure. In Group 2, 18 cases were treated with a single dose of sulfadoxine 30 mg per kg body wt and pyrimethamine 1.5 mg per kg body wt. Two cases (11.1%) were cured (S), while 7 cases (38.9%) showed RI failure, 7 cases (38.9%) RII failure and 2 cases (11.1%) RIII failure. In Group 3, 23 cases were treated with quinine 10 mg base per kg body wt 8 hourly for 5 days plus sulfadoxine 20 mg per kg body wt and pyrimethamine 1.0 mg per kg body wt, single dose given with the last dose of quinine. Thirteen cases (56.5%) were cured (S), while 10 cases (43.5%) showed RI failure.