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Response of Plasmodium falciparum to chloroquine and Fansidar in vivo and chloroquine and amodiaquine in vitro in Uganda.
East Afr Med J. 1995 Jun; 72(6):349-54.EA

Abstract

The response of P. falciparum to chloroquine and pyrimethamine-sulfadoxine in vivo and chloroquine and amodiaquine in vitro was investigated in parasitaemic school children from six locations. Mean parasite sensitivity to chloroquine at day 7 was 74% (range 61-97) with parasite clearance rates between 2-3 days and complete defervescence in 85% of febrile children. Sensitivity declined in the four sites followed up to day 14 to 45% (range 37-53). Parasites were significantly more sensitive to pyrimethamine/sulfadoxine at 5/6 sites (100% day 7) but 5% of subjects became parasitaemic by day 14. In vitro isolates were significantly less sensitive to chloroquine than to amodiaquine with a mean 99% effective concentration of 348 mumol/L compared to 6.44 mumol/L. Clearly the role of chloroquine as the primary therapy for uncomplicated P. falciparum malaria should be reconsidered especially in the light of increasing disease severity and resurgence. Amodiaquine may be suitable alternative with pyrimethamine/sulfadoxine as second line and for more severe malaria prior to referral. The cost of alternative antimalarials and the dynamic and deteriorating pattern of resistance are powerful arguments for more objective slide diagnosis to minimise drug pressure and a regular drug sensitivity surveillance system. We believe that the latter should concentrate on measuring clinical drug efficacy in symptomatic outpatients rather than in asymptomatic children while the former needs more pragmatic and economical strategies possibly centred on seasonality and risk.

Authors+Show Affiliations

Malaria Unit, Department of Community Health, African Medical and Research Foundation (AMREF), Nairobi, Kenya.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7498001

Citation

Nevill, C G., et al. "Response of Plasmodium Falciparum to Chloroquine and Fansidar in Vivo and Chloroquine and Amodiaquine in Vitro in Uganda." East African Medical Journal, vol. 72, no. 6, 1995, pp. 349-54.
Nevill CG, Ochen K, Munafu CG, et al. Response of Plasmodium falciparum to chloroquine and Fansidar in vivo and chloroquine and amodiaquine in vitro in Uganda. East Afr Med J. 1995;72(6):349-54.
Nevill, C. G., Ochen, K., Munafu, C. G., Bekobita, D., & Sezi, C. L. (1995). Response of Plasmodium falciparum to chloroquine and Fansidar in vivo and chloroquine and amodiaquine in vitro in Uganda. East African Medical Journal, 72(6), 349-54.
Nevill CG, et al. Response of Plasmodium Falciparum to Chloroquine and Fansidar in Vivo and Chloroquine and Amodiaquine in Vitro in Uganda. East Afr Med J. 1995;72(6):349-54. PubMed PMID: 7498001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Response of Plasmodium falciparum to chloroquine and Fansidar in vivo and chloroquine and amodiaquine in vitro in Uganda. AU - Nevill,C G, AU - Ochen,K, AU - Munafu,C G, AU - Bekobita,D, AU - Sezi,C L, PY - 1995/6/1/pubmed PY - 1995/6/1/medline PY - 1995/6/1/entrez SP - 349 EP - 54 JF - East African medical journal JO - East Afr Med J VL - 72 IS - 6 N2 - The response of P. falciparum to chloroquine and pyrimethamine-sulfadoxine in vivo and chloroquine and amodiaquine in vitro was investigated in parasitaemic school children from six locations. Mean parasite sensitivity to chloroquine at day 7 was 74% (range 61-97) with parasite clearance rates between 2-3 days and complete defervescence in 85% of febrile children. Sensitivity declined in the four sites followed up to day 14 to 45% (range 37-53). Parasites were significantly more sensitive to pyrimethamine/sulfadoxine at 5/6 sites (100% day 7) but 5% of subjects became parasitaemic by day 14. In vitro isolates were significantly less sensitive to chloroquine than to amodiaquine with a mean 99% effective concentration of 348 mumol/L compared to 6.44 mumol/L. Clearly the role of chloroquine as the primary therapy for uncomplicated P. falciparum malaria should be reconsidered especially in the light of increasing disease severity and resurgence. Amodiaquine may be suitable alternative with pyrimethamine/sulfadoxine as second line and for more severe malaria prior to referral. The cost of alternative antimalarials and the dynamic and deteriorating pattern of resistance are powerful arguments for more objective slide diagnosis to minimise drug pressure and a regular drug sensitivity surveillance system. We believe that the latter should concentrate on measuring clinical drug efficacy in symptomatic outpatients rather than in asymptomatic children while the former needs more pragmatic and economical strategies possibly centred on seasonality and risk. SN - 0012-835X UR - https://www.unboundmedicine.com/medline/citation/7498001/Response_of_Plasmodium_falciparum_to_chloroquine_and_Fansidar_in_vivo_and_chloroquine_and_amodiaquine_in_vitro_in_Uganda_ DB - PRIME DP - Unbound Medicine ER -