The Response of P.falciparum to 4-Amonioquinolines and Pyrimethamine sulfadoxine in 6 sites scattered throughout Uganda

Due to the absence of audience reprots from Uganda on the Chloroquine (CQ) treatment failure of P.falciparum and Pyrimethamine sulfadoxine (PSD) combination; the need for a study to demonstrate the response for P.falciparum to these drugs was obvious. We accordingly assessed the response of P.falciparum malaria in primary school children from six sites scattered throughout Uganda during the month of July and Agust 1988. The standardised WHO in vivo and in vitro micro test methods were employed. A total of 3999 primary school children were screened from the six sites and of these 780(20) had malaria. While Arua had the highest rate of CQ sensitivity of 97.2; Kampala had the lowest rate of 60.5. R3 cases were detected at only two of the six sites namely Kampala with 1 case (2.3) and Jinja with also one case (2.9). PSD were sensitive by day 7 but 3 of the 60 cases (5) become parasitaemic by day 7. In vitro P. falcuparum isolates were significantly more sensitive to amodiaquine (AQ) at all sites with a mean EC 99 of 6.443u mol/L compared to 347.7u mol/L for CQ (p0.001). There was correlation between the in vitro sensitivities. We; therefore; recommend that CQ should continue to be the first line drug for the treatment of malaria in Uganda but may use PSD or AQ for slide confirmed P. falciparum resistant to CQ as the second line drugs. Quinine should also be readily available for malaria unrespondive to CQ. Source: Uganda Med. J. Vol. 8 no. 2+4; Sept.-Dec. 1991

Daily low dose chlorproguanil is an effective alternative to daily proguanil in the prevention of P. falciparum malaria in Kenya

156 coastal schoolchildren participated in a placebo controlled trial. All the children were treated with chloroquine 25mg/kg over 3 days plus single dose pyrimethamine-sulfadoxine and then randomised to receive one of four regimens:- A:7.5 mg chlorproguanil daily; B: 50 mg chlorproguanil weekly; C: 100mg proguanil daily; D: 100 mg Calcium lactate weekly. The children were followed up daily for 169 days for P.falciparum parasitaemia. Each 'terminal' event for the construction of life table; was treated with single dose pyrimethamine-sulfadoxine and the child removed from the trial. At the end of the study; 34/37 children had suffered a terminal event in the placebo group compared to 12/39 in the daily proguanil 100 mg group; 15/39 in the daily chlorproguanil 7.5 mg group and 22/40 in the weekly chlorproguanil 50 mg group. Life table analysis found a significant reduction (P is greater than 0.001) in the risk of malaria in all the chemoprophylactic groups compared to the placebo group. Daily proguanil also gave greater protection than weekly chloroproguanil (P greater than 0.05); but there was no difference between daily proguanil and daily chlorproguanil (P less than 0.1). Daily chlorproguanil 7.5 mg; has a lower cumulative dose; greater in vitro activity and increased intracellular concentration of the metabolite. Compared to proguanil and increased intracellular concentration of the metabolite. Therefore; daily proguanil has significant potential as another chealp; effective; nontoxic chemoprophylactic addition to vector avoidance measures