PROSPECTIVE COMPARISON OF METHODS FOR THE EARLY PREDICTION OF TREATMENT FAILURE IN PATIENTS WITH FALCIPARUM-MALARIA

The prompt identification of patients with falciparum malaria who are at risk of late therapeutic failure could help clinicians avoid the da ngers of missed or delayed retreatment. Different methods for predicti ng late recrudescence were compared for 52 patients whose parasitemia initially cleared after treatment with either halofantrine or quinine, Parasites reappeared in the peripheral circulation of six individuals 17 to 28 days after the initiation of therapy. Transient rises in par asite counts on thick blood films were accurate (91% specific and 100% sensitive) and prompt indicators of eventual recrudescence. All six t herapeutic failures had been predicted by the third day (mean time [+/ -SEM], 51.5 +/- 3.6 hours) after initiation of treatment. Parasite cle arance time, fever clearance time, rRNA probe, and the polymerase chai n reaction had less practical prognostic value, Serial thick-film para site counts are a simple, cheap, rapid, and reliable method for identi fying patients at high risk of recrudescence.