A COMPARATIVE-STUDY OF PARENTERAL CHLOROQUINE, QUININE AND PYRIMETHAMINE-SULFADOXINE IN THE TREATMENT OF GAMBIAN CHILDREN WITH COMPLICATED,NON-CEREBRAL MALARIA

Ninety-two children with complicated, but not cerebral, Plasmodium fal ciparum malaria, aged 1-9 years, were recruited between August 1992 an d December 1994 to an open, randomized trial of parenteral chloroquine (28), pyrimethamine-sulfadoxine (P-S) (36) and quinine (28). The medi an fever clearance time was shorter for chloroquine (27 hours) than fo r quinine (42 hours) or for P-S (36 hours) (p = 0.02 and p = 0.06, res pectively). The parasite clearance times were similar for chloroquine and P-S, but significantly shorter for chloroquine compared with quini ne (54 hours vs 66 hours) (p = 0.007) and for P-S compared with quinin e (42 hours vs 66 hours) (p < 0.001). However, three children who rece ived chloroquine and three who received P-S required a change to treat ment with quinine because of a clinical failure of their initial treat ment. Four children died, one in the chloroquine group, one in the qui nine group and two in the P-S group. Despite a high level of chloroqui ne resistance in the community, the majority of Gambian children with complicated malaria responded satisfactorily to parenteral chloroquine given under supervision. The clinical failure rates of chloroquine an d P-S were similar. Parenteral chloroquine and P-S remain adequate tre atments for complicated, non-cerebral malaria in Gambian children, pro vided children can be kept under close clinical observation so as to d etect early any treatment failures. Parenteral P-S has the advantage t hat only one dose is required.