Sulphadoxine/pyrimethamine: an appropriate first‐line alternative for the treatment of uncomplicated falciparum malaria in Ghanaian children under 5 years of age

• Published in: Tropical medicine & international health Vol. 7; no. 7; pp. 577 - 583
• Main Authors: Driessen, G. J. A., Van Kerkhoven, S., Schouwenberg, B. J. J. W., Bonsu, G., Verhave, J. P.
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01-07-2002; Blackwell Science
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimalarials - therapeutic use; Antiparasitic agents; Biological and medical sciences; Child, Preschool; children; chloroquine; Chloroquine - therapeutic use; Drug Combinations; Drug Resistance; Female; Follow-Up Studies; Ghana; Human protozoal diseases; Humans; Infant; Infectious diseases; Malaria; Malaria, Falciparum - diagnosis; Malaria, Falciparum - drug therapy; Male; Medical sciences; Outpatients - statistics & numerical data; Parasitic diseases; Pharmacology. Drug treatments; Protozoal diseases; Pyrimethamine - therapeutic use; randomized trial; Sulfadoxine - therapeutic use; sulphadoxine–pyrimethamine; Treatment Failure; Treatment Outcome; treatment policy; Tropical medicine; Ghana; Africa; Parasitological investigation; Sulfanilamide derivatives; Antimalarial; Protozoal disease; Kaplan Meier estimator; Chloroquine; Plasmodium falciparum; Microbiological investigation; Clinical biology; Sulfadoxine; Child; Human; Protozoa; Apicomplexa; Treatment resistance; Statistical analysis; Sulfonamide; Hematology; Malaria; Treatment efficiency; Pyrimethamine; Exploration; Parasitosis; Infection; Chemotherapy; Treatment; Comparative study
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1046/j.1365-3156.2002.00910.x

OBJECTIVE  To assess whether chloroquine (CQ) still is an appropriate first‐line drug for the treatment of uncomplicated falciparum malaria in Ghana and whether sulphadoxine/pyrimethamine (SP) could be a good alternative.
METHOD  The parasitological, clinical and haematological responses to CQ and SP were studied in children < 5 years of age according to a modified WHO 28‐day in vivo protocol. A total of 142 children attending the outpatients department meeting the inclusion criteria were randomly assigned to the CQ (n=72) or SP (n=70) group.
RESULTS  In the CQ group, 15 children (20.8%) exhibited early clinical failure (within 3 days) compared with only 1 (1.4%) in the SP group (P < 0.01). The clinical failure rate before day 14 (early treatment failure plus late treatment failure before day 14) also showed a marked advantage in favour of the SP group (1.4 against 29.2%). The median time to clinical failure was 11.5 days in the CQ group and 26 days in the SP group (P < 0.01). Of the 72 children treated with CQ, 9 (12.5%) had RIII resistance and 19 (26.4%) had RII resistance. A total of 36 (50.0%) were sensitive to CQ. From the 70 children treated with SP, none had RIII or RII resistance. There was no difference in haematological response between the two treatment groups.
CONCLUSION  Although there is little concordance on when to change treatment policy, the high resistance to CQ in this study supports the change to another first‐line drug for children under 5 years of age. SP seems to be a good alternative, although a high RII and RIII resistance against this drug has already been reported in the coastal zones of Ghana.