Cardiac effects of halofantrine in children suffering from acute uncomplicated falciparum malaria.

The cardiac effects of halofantrine were assessed in 42 children with acute symptomatic uncomplicated Plasmodium falciparum malaria by electrocardiographic (ECG) and clinical monitoring over a period of 14 d. The children were treated with oral halofantrine 8 mg/kg body weight every 6 h for 3 doses. There was significant prolongation of the P-R interval (compared with the pre-treatment value) only at 8 h after drug administration. However, first degree auriculoventricular (AV) block occurred in 2 children at 8 h or 8 and 48 h, and second degree AV block in another child at 48 h. There was significant prolongation of the Q-Tc interval at 8, 16, 24, 48 and 72 h after treatment; the proportions of children with Q-Tc interval > 0.44 s were also significantly higher at all these times except 72 h. Rhythm disturbance was rare. There was no significant ECG change at 168 or 336 h. Despite the ECG abnormalities, there was no clinical symptom. These findings indicate that, in children, the currently recommended dose of halofantrine for the treatment of falciparum malaria may produce serious cardiac side effects.

Comparative efficacy of halofantrine, chloroquine and sulfadoxine-pyrimethamine for treatment of acute uncomplicated falciparum malaria in Nigerian children.

One hundred and ten children aged 6 months to 11 years were randomly treated with halofantrine (HF), sulfadoxine-pyrimethamine (S-P) or chloroquine (CQ) for acute uncomplicated Plasmodium falciparum malaria in an endemic area of south-western Nigeria. The response of infection to treatment in each child was monitored for 14 d. The mean fever clearance times were 1.9 d (n = 36), 1.6 d (n = 27), and 1-7 d (n = 28) for children treated with HF, S-P and CQ, respectively. The parasite clearance times were 3.4 d (n = 39), 4.4 d (n = 24) and 4.1 d (n = 15) in the 3 groups of children. The cure rate at day 7 was 92.3% (36/39) in children treated with HF, 72.7% (24/33) in those treated with S-P, and 39.5% (15/38) in those treated with CQ. By day 14, 4 of 36 (11.1%) parasitologically cured patients treated with HF had experienced recrudescences. The corresponding figures among children treated with S-P or CQ were 8.3% and 13.3%, respectively. The 3 drugs were well tolerated. The results of the study showed a further decline in the sensitivity of P. falciparum infections to CQ, while HF and S-P remained relatively effective in the treatment of malaria in south-west Nigeria.