Clindamycin treatment of falciparum malaria in Brazil.

Oral treatment with clindamycin (5 mg/kg twice a day, for five consecutive days) was studied in patients with uncomplicated falciparum malaria in Acre, Brazil, an area with multiresistant Plasmodium falciparum. Parasitaemia ranged between 12 and 79560/microliters of blood admission. Thirty-five out of 44 patients admitted to the study could be followed up for 28 days. Only two patients showed parasitaemia six days after admission, and no asexual parasites were observed by day seven. Twenty-eight days after admission all patients were cured. Of the nine patients withdrawn from the study, five were lost during follow up and four needed different treatment (quinine 15 mg/kg twice a day, for ten days) because clinical symptoms did not improve within 60 h after admission. These patients had experienced their first attack by P. falciparum. In individual cases oral clindamycin can be used as an alternative treatment in semi-immune patients with uncomplicated falciparum malaria from an area where multiresistant parasites frequently occur. However, because of the slow response in all cases described here, and the risk of development of resistance if clindamycin is used alone it cannot be recommended as monotherapy in non-immune patients.

Minoxidil in the management of moderate hypertension.

The effects of minoxidil used in combination with propranolol were assessed in the management of moderate hypertension. All patients had diastolic blood pressures above 95 mm Hg after therapy with thiazide diuretics for 2 weeks and were randomly assigned to treatment schedules which added minoxidil and propranolol in dosage ratios of 1:2, 1:4, and 1:8. Diastolic pressures were reduced to less than 90 mm Hg by upward titration of minoxidil dosage, minoxidil was discontinued; 2 weeks later propranolol was also withdrawn. A diastolic pressure less than 90 mm Hg was achieved with 5 mg of minoxidil in 50% of the patients. While vasodilator-induced tachycardia was blocked at all minoxidil/propranolol ratio, the 1:8 ratio group demonstrated the greatest percentage reduction in systolic and diastolic pressures at the end of the first week. We conclude that rapid control of moderate hypertension can be achieved by modest doses of minoxidil and with the production of only minor side effects, a minoxidil/propranolol ratio of 1:8 being adequate to prevent tachycardia.