The impact of malaria chemoprophylaxis in Africa with special reference to Madagascar, Cameroon, and Senegal.

Some past and present experiences in the use of antimalarial drugs, particularly for chemoprophylaxis, are reviewed. The failure in the long term of mass chemoprophylaxis with weekly chloroquine in children in Madagascar, Cameroon, and Senegal is discussed, the reasons for failure being an increasing lack of resources to ensure regular drug distribution and lack of supervision of dosage.The increasing number of reports confirming chloroquine resistance from East Africa over the last decade poses a serious threat to the future usefulness of chloroquine as an antimalarial agent in Africa. There is now an urgent need for extensive drug sensitivity tests, which should also include alternative antimalarial drugs. To rely on mass chemoprophylaxis as the main method of controlling malaria would appear to be no longer tenable.

Rifampicin for lepromatous leprosy: nine years' experience.

Over 100 patients with lepromatous leprosy were treated with rifampicin in a series of pilot, uncontrolled, and controlled trials in 1968-77. The rapid bactericidal effect of rifampicin on Mycobacterium leprae was confirmed. Clinical improvement became apparent sometimes as early as 14 days after the start of treatment. Nevertheless, a few persisting viable M leprae were detected as long as five years after the start of treatment with rifampicin either by itself or in combination with the bacteriostatic drug thiambutosine. Treatment with rifampicin and dapsone for six months reduced the number of persisting leprosy bacteria more than treatment with dapsone alone. Although rifampicin proved more effective than dapsone, it is unlikely that used by itself if can significantly shorten the length of treatment in lepromatous leprosy. Therefore initial intensive combined treatment with two or more bactericidal drugs (including rifampicin) warrants further investigation in both untreated leprosy and lepromatous leprosy resistant to dapsone.

Rifampicin for lepromatous leprosy: nine years experience

Over 100 patients with lepromatous leprosy were treated with rifampicin in a series of pilot, uncontrolled, and controlled trials in 1968-77. The rapid bactericidal effect of rifampicin on Mycobacterium leprae was confirmed. Clinical improvement became apparent sometimes as early as 14 days after the start of treatment. Nevertheless, a few persisting viable M leprae were detected as long as five years after the start of treatment with rifampicin either by itself or in combination with the bacteriostatic drug thiambutosine. Treatment with rifampicin and dapsone for six months reduced the number of persisting leprosy bacteria more than treatment with dapsone alone. Although rifampicin proved more effective than dapsone, it is unlikely that used by itself if can significantly shorten the length of treatment in lepromatous leprosy. Therefore initial intensive combined treatment with two or more bactericidal drugs (including rifampicin) warrants further investigation in both untreated leprosy and lepromatous leprosy resistant to dapsone.

Combinations of 4-aminobenzoic acid competitors and dihydrofolate dehydrogenase inhibitors in the chemotherapy of malaria. A commentary.

Potentiating combinations of 4-aminobenzoic acid (PABA) competitors, such as sulfadoxine, sulfalene, or dapsone, and dihydrofolate dehydrogenase(a) (1.5.1.4) inhibitors, such as pyrimethamine or proguanil, have been subjected to various trials over the last decade. By and large they have proved to be effective agents against drug-resistant strains of malaria parasites, and with the small doses required they have been free of toxic effects. Parasite resistance to such combinations has seldom occurred but may be associated with cross-resistance to other combinations. These combinations should be reserved for the treatment of chloroquine-resistant infections and for use as adjuvants in organized malaria eradication campaigns.