ABSTRACT
One hundred and eleven adult patients who attended North Okkalapa General Hospital for uncomplicated falciparum malaria were chosen for the study. They were treated with dihydroartemisinine (Cetexin), quinine, artesunate tablets and artemether injection. Fifty nine adult male and female without malaria were chosen as controls. They were treated with sulfadoxine-pyrimethamine, quinine and artesunate. Thick and thin blood films were taken from the patients daily and were stained and counted for malaria parasites. Packed cell volume (PCV), WBC count and reticulocyte count were also done. Among the patients treated with drugs, there was a significant fall in the mean reticulocyte count (number concentration and number fraction) at day 3. But the reticulocytes were raised back to normal at days 7 and 14. There was no significant changes in the mean packed cell volume (PCV) and mean level of total WBC count of the patients in all 4 groups. Among normal controls treated with artesunate tablets, there was also a significant fall in the mean reticulocyte count at day 3 but the mean reticulocytes count was also raised back to normal at days 7 and 14. Among normal controls treated with quinine and sulfadoxine-pyrimethamine tablets, there was no significant fall in the mean reticulocyte count. And there was no significant changes in PCV and WBC count in all 3 groups of controls. The fall in reticulocyte counts can be due to part of the disease malaria as well as to the drug including quinine and not singly to artemisinine therapy alone.
Subject(s)
Antimalarials , Malaria, FalciparumABSTRACT
In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.
Subject(s)
Quinine , Mefloquine , MyanmarABSTRACT
The effect of chloroquine, sulfadoxine- pyrimethamine and chloroquine plus sulfadoxine-pyrimethamine were studied on 97 patients with uncomplicated falciparum malaria. 53. 1 per cent of the patients were resistant to chloroquine at R2 and R3 level. Among patients treated with sulfadoxine- pyrimethamine, 25 per cent were resistant to the same level. But, when chloroquine is combined with sulfadoxine-pyrimethamine only 12.1 per cent of the patients were resistant at R2 level. There were no patients who were resistant at R3 level to the combined drugs. All the patients were free from toxicity that can be related to the two drugs. Apart from simple additive effect, there may also have the potentiating effect of combining two drugs. Hence for a developing country like Myanmar with the problem of multidrug resistance, this method of treatment may be considered for semi-immune patients with uncomplicated falciparum malaria.
Subject(s)
Chloroquine , Malaria, Falciparum , Antimalarials , MyanmarABSTRACT
Two hundred and four consecutive patients with P. falciparum malaria who attended Tharrawaddy Civil Hospital during 1990 and 1991 malaria seasons were studied. The factors such as age group, sex, parasite density, body temperature, presence of pregnancy and clinical categories of the patients were related to the plasma glucose level of the patients, 180 plasm samples from the patient's attendants and 54 plasma samples from patients with P. vivax malaria who attended to the same hospital were also included in the study as controls. High percentage of patients with hypoglycaemia (< 40 mg/dl) was present in patients with cerebral malaria, patients with high parasite density and women with pregnancy. But there was no significant difference between these groups of patients and controls. Hypoglycaemia in falciparum malaria may be multi-factorial and not due to single cause.
Subject(s)
Malaria, Falciparum , Hypoglycemia , Quinine , MyanmarABSTRACT
The patients who attended the out patients cllinic of Thayarwaddy Civil Hospital and North Okkalapa General Hospital were treated with chloroquine (600 mg base at days 0 and 1 and 300 mg base at day 2). To those who failed to clear the parasites at 72 hours were treated with 3 tablets of sulfadoxine pyrimethamine (each containing 500 mg sulfadoxine and 25 mg pyrimethamine). To those who failed again to clear the parasites at 72 hours were treated with one of the following drugs at alternate sequence. (1) 50 mg Artesunate tablets were given twice a day for 5 days orally. The initial dose was double. (2) Quinine sulphate tablets 600 mg 3 times per day given orally for 7 days. Total 60 patients were studied.In both groups of patients parasites were cleared at 72 hours and at day 4. The parasite clearance time and fever clearance time of the patients treated with the two different drugs were not statistically different. All patients treated with artesunate can tolerate the drug and were free from side effects that can be related to the drug. Out of 18 patients who were followed till day 28,6 patients recrudesced at days between 21 and 28. Among the patients treated with quinine 50 percent failed to complete the drug course. Out of 10 patients who were followed till day 28, one patient recrudesced at day 21. We conclude that Artesunate or quinine alone are effective but may not be useful for treatment of drug resistant malaria.
Subject(s)
Quinine , Chloroquine , Drug ResistanceABSTRACT
The effect of three doses of intramuscular quinine followed by oral quinine on ten adults and ten children with falciparum malaria (half of each group were highly parasitised) were studied. There were no complications associated with this method of therapy. the level of serum quinine in all the adults reached above the minimal inhibitory concentration (MIC) from the 2nd hour of the drug administration. So this method of administration should be recommended for severely ill patients before referral to hospitals. Anong the children, eight responded well to the therapy and the serum quinine level rose above MIC level from the second hour as in adults. There were two patients who failed to respone to the treatment. One had persistantly high level of quinine and was misdiagnosed as a case of cerebral malaria instead of quinine toxicity. He responded well when quinine was omitted and replaced with mefloquine. Another child had persistantly low level of quinine. He developed cerebral sings and symptoms and also responded well to mefloquine. Thus it is suggested that the level of serum quinine should be monitroed in children if possible, or toxicity ot quinine should be watched.
Subject(s)
Quinine , MyanmarABSTRACT
Serum samples from 115 patients with falciparum malaria who attended Tharyarwady Civil Hospital during summer and rainy seasons of 1991 were studied. Of these, 71 patients were followed at Day (7) of admission to the hospital. the sera were tested by tube agglutination for antibodies against H and O suspension of enteric fever organisms (Salmonella typhi, Salmonella paratyphi A and Salmonella paratyphi B). 3 samples of sera collected from patients with parasite density (1+) and suffering from uncomplicated malaria showed agglutination titre + 1/40 to 0 and H antigens of Salmonella typhi. One serum sample collected from a patient with parasite density (2+) and suffering from uncomplicated malaria showed agglutination titre + 1/40 to 0
Subject(s)
Agglutination Tests , Malaria, Falciparum , MyanmarABSTRACT
Sixty patients with uncomplicated falciparum malaria (less than 5 Percent of RBCs parasitised) were studied. Patients were alternatively assinged to treat with Halofantrine or Quinine. Halofantrine was given orally 500 mg six hourly for three doses. Quinine 10 mg/kg was given orally three times a day for 7 days. All the patients were admitted to the hospsital for 7 days and were followed up on days 14, 21 and 28. There were no differences in parasite clearance time and fever clearance time between two groups of patients. Among the apatients treated with Quinine two faile to complete the durg course. In one patient who was treated with Halofantrine, the initial parasite count was 171429 cumm at O hour of admission to hospital. The parasites were cleared at 42 hours and he became unconscious at 48 hours. He was put on standard dose of Artemether plus Mefloquine, but the patient became deeply jaundice and expired at 72 hours of admission to hospital. We concluded that further studies are needed to evaluate the efficacy of Halofantrine on Myanmar patients with complicate fallciparum malaria.
Subject(s)
Quinine , Antimalarials , MyanmarABSTRACT
The relationship between the levels of FDP in the serum, parasite count and the severity of the clinical manifestations were studied in 89 patients with falcoparum malaria. Serum FDP levels were found to be related to the level of asexual parasite count as well as to the severity of the clinical manifestations of falciparum malaria. It is thus suggested that the measurement of serum FDP can be used to identify hihg risk group of falciparum malaria cases.
Subject(s)
Malaria, Falciparum , Fibrin Fibrinogen Degradation Products , Disseminated Intravascular Coagulation , Hemostatics , MyanmarABSTRACT
This preliminary study was done to monitor the changing trend in sensitivity of anti-malarials at a fixed hospital in central Burma near Pegu Mountain Range. During 1986 malarial season out of 15 patients treated with chloroquine (6.6per cent) was resistant at R2 level and (73.3 per cent) were resistant at R1 level. Remaining 20 per cent of patients were either S (sensitive)of R1 (resistant). Out of 29 patients treated with amodiaquine (6.9 per cent) were resistant at R2 level and (51.7 per cent) were resistant at R1 level. (13.8 per cent) patients were proved as sensitive and the remaining (27.6 per cent) patients were either S (sensitive) or R1 (resistant). Out of 24 patients treated with sulphadoxine pyrimethamine (16.7 per cent) were resistant at R2 level. 50 per cent were resistant at R1 level. (20.8 per cent) cases were sensitive to the drug. The remaining 12.5 per cent of patients were either S (sensitive) or R1 (resistant). Out of 31 patients treated with quinine (6.5 per cent) were resistant at R2 llevel. (9.7 per cent) were resistant at R1 level. (48.3 per cent) were sensitive to the drug. Remaining (35 per cent) were either S (sensitive) or resistant at R1 level. Out of 35 patients treated with mefloquine sulphadoxine pyrimethamine (3.0 per cent) was resistant at R2 level. (12.1 per cent) were resistant at R1 level. (69.6 per cent) were sensitive to the drug and the remaining (15.2 per cent) of patients were either S or R1 resistant. The problems faced with the present method of drug monitoring will be discussed. Although re-infection during the follow up period could not be totally excluded it may be concluded that significant resistance to quinine exists and mefloquine resistance may also become a problem in the not too distant future.
Subject(s)
Antimalarials , Plasmodium falciparum , Drug MonitoringABSTRACT
A total of 10 patients (adults) with highly parasitized falciparum malaria were treated initially with intravenous quinine (10 mg per kg quinine diluted in 20 ml normal saline injected very slowly with a syringe taking not less than 20 minutes). Six control patients were treated with quinine infusion standard method (quinine 10 mg/kg diluted in 500 ml of normal saline given as slow drip taking 4 hours for the drug to enter the patient's body). Both two groups of patients were followed by oral quinine 10 mg/kg three times a day for 7 days.