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Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1–4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6–48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0–48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2. and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.
Received March 17, 2003. Accepted for publication July 23, 2003.
Acknowledgments: We thank the children, their families, and the staff at Kibaha Hospital for their participation in this study. Special thanks are given to Fredrick Kalokola, Jeremiah Masunga (deceased), and Anette Sundstedt for laboratory work and organization at the hospital. We are grateful to Margareta Hagstedt and Hedvig Perlmann for technical assistance with the antibody enzyme-linked immunosorbent assay, and Jan Kowalski for statistical expertise. We also thank Amos Y. Massele, Anita Östborn, Ulrika Uddenfeldt, Ib Bygbjerg, and Anita Rønn for their contributions in making the study possible.
Financial support: The work was supported by Swedish International Development Co-operation Agency (Stockholm, Sweden).
Authors’ addresses: Elisabeth Hugosson, Malaria Research Unit (M9), Division of Infectious Diseases, Department of Medicine, Karolinska Hospital, 17176 Stockholm, Sweden, Telephone: 46-8-5177-6739, Fax: 46-8-5177-6740, E-mail: ehugosson{at}hotmail.com. Donath Tarimo and Zul Premji, Department of Parasitology/Medical Entomology, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, Telephone: 255-22-215-1596, Fax: 255-22-215-0465, E-mails: dtarimo{at}muchs.ac.tz and zpremji{at}muchs.ac.tz. Marita Troye-Blomberg, Department of Immunology, Stockholm University, Stockholm, Sweden, Telephone: 46-8-164-164, Fax: 46-8-612-9542 or 46-8-157-356, E-mail: marita{at}imun2.su.se. Scott M. Montgomery, Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet, 17176 Stockholm, Sweden, Telephone: 46-8-5177-9325, Fax: 46-8-5177-9304, E-mail: Scott.Montgomery{at}medks.ki.se. Anders Björkman, Malaria Research Unit (M9), Division of Infectious Diseases, Department of Medicine, Karolinska Hospital, 17176 Stockholm, Sweden, Telephone: 46-8-5177-1866, Fax: 46-8-5177-6740, E-mail: anders. bjorkman{at}ks.se.
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  S. L. PITMANG, T. D. THACHER, J. K. A. MADAKI, D. Z. EGAH, and P. R. FISCHER COMPARISON OF SULFADOXINE-PYRIMETHAMINE WITH AND WITHOUT CHLOROQUINE FOR UNCOMPLICATED MALARIA IN NIGERIA Am J Trop Med Hyg, March 1, 2005; 72(3): 263 - 266. [Abstract] [Full Text] [PDF]
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