Comparative assessment of the clinical performance of chloroquine and sulphadoxine/pyrimethamine in the treatment of Plasmodium falciparum infection in Plateau State: an open randomised study of 109 children with acute uncomplicated malaria
AbstractBackground: Malaria remains one of the most common threats to child survival in Nigeria. Chloroquine (CQ) is the first line drug of choice against uncomplicated malaria. In view of reports indicating an increasing resistance of P. falciparum to CQ, a regular surveillance of malaria therapy requires constant evaluation of its efficacy and that of suitable alternatives.
Objective: To compare the current efficacy of CQ with that of sulphadoxine/pyrimethamine (SP) in the treatment of P falciparum infection in Plateau State.
Patients and Methods: Using a 14-day protocol, an open randomized study of the efficacy of CQ and SP in the treatment of uncomplicated P. falciparum infection was conducted in 109 febrile children under five years of age in the Barkin Ladi Local Government Area of Plateau State. Adequate clinical response (ACR), adequate clinical and parasitological response (ACPR) and clinical efficacy (CE) were assessed in the two treatment groups.
Results: Out of the 708 children screened for P. falciparum parasitaemia, 378 (53.4 percent) tested positive. One hundred and nine of the 115 children who qualified for enrollment, completed the study. Fifty-four and 55 children received CQ and SP, respectively. The mean (SD) duration of illness before presentation at the hospital was 1.5 (0.71) days. The means of age, temperature, packed cell volume and parasite counts on admission to the study were similar in the two treatment groups. Thirty-nine (75 percent) of the 52 children who received CQ, and in respect of whom the data was complete, attained clinical cure compared to 52 (94.5 percent) of 55 children on SP (p= 0.013). Twenty-seven (51.9 percent) of 52 children treated with CQ versus 48 (87.3 percent) of 55 children on SP achieved adequate clinical and parasitological cure (p=0.00010). Thirty (57.7 percent) of 52 children on CQ versus 48 (87.3 percent) of 55 children who received SP were clinically cured (p = 0.0012). Failure to achieve fever clearance by day 14 was noted in eight (16.7 percent) of 48 children on CQ against four (7.3 percent) of 55 children on SP.
Conclusion: Although both drugs fell short of a hundred percent cure rate, CQ performed less creditably than SP in the treatment of uncomplicated malaria. There appears to be an urgent need to seek other effective alternative first-line anti-malarial drugs in the country.
Nigerian Journal of Paediatrics Vol. 31(3) 2004: 87-92