RESISTANCE IN-VIVO OF PLASMODIUM-FALCIPARUM TO COTRIMOXAZOLE IN WESTERN UGANDA

In the context of the 'integrated management of childhood illnesses' ( IMCI) programme the World Health Organization recommends treating chil dren in malarious areas presenting with fever and respiratory symptoms with co-trimoxazole. In order to verify its effectiveness in uncompli cated Plasmodium falciparum malaria we carried out a study in vivo in western Uganda: 180 children under 5 years old were enrolled and treat ed with 40/8 mg/kg/d co-trimoxazole over 5 d, and 159 could be followe d on days 3, 7 and 14. Effectiveness of treatment was found to be sign ificantly different in various parts of the study area. In Bundibugyo District, bordering Republique Democratique du Congo (Zaire), 59.1% (3 9/66) of children were clinically cured after 14 d and 56.1% were para sitologically cured. In the east of Kabarole District (43 children), t he figures were 76.7% and 65.1%, respectively. In western Kabarole (50 children) the rates were 96.0% and 90.0%, respectively. We conclude t hat, in view of the high level of clinical failures in parts of the st udy area, co-trimoxazole should not be used in the IMCI programme for combined treatment of malaria and pneumonia in the region. Assessment of therapeutic effectiveness of antimalarial drugs needs to consider t he microepidemiology of resistance.