Comparative efficacy of chloroquine plus chlorpheniramine alone and in a sequential combination with sulfadoxine-pyrimethamine, for the treatment of acute, uncomplicated, falciparum malaria in children

One hundred and eight children with acute, symptomatic, uncomplicated, falc iparum malaria were randomized to receive chloroquine (for 3 days) plus chl orpheniramine alone (for seven days) (CQ-CP group; N = 55) or, in a sequent ial treatment, chloroquine plus chlorpheniramine for 3 days followed, on th e fourth day, by a single oral dose of sulfadoxine-pyrimethamine (25 mg sul fadoxine/kg) (CQ-CP-SP group; N = 53). The mean (S.D.) parasite-clearance t ime in the CQ-CP group [2.1 (0.7) days; range = 1-5 days] was similar to th at in the CQ-CP-SP [2.1 (0.8) days; range = 1-5 days]. The fever-clearance times were also similar: 1.2 (0.1) days (range = 1-3 days) v. 1.1 (0.4) day s (range = 1-3 days). The cure rates on days 14, 21 and 28 were 98.2%, 96.3 % and 92.7%, respectively in the CQ-CP group, and 100%, 100% and 96.2%, res pectively, in the CQ-CP-SP group The rates of gametocyte carriage were low and similar (5.4% in the CQ-CP group and 3.8% in the CQ-CP-SP group) throug hout the duration of the study. Both treatment regimens were relatively wel l tolerated, the main adverse reactions being similar: sleepiness (on day 1 ) and pruritus (on days 1-3). No adverse effect was attributable to SP. The results indicate that sequential treatment, for 3 days with CQ and CP, followed by a single dose of SP, is effective and well tolerated in childre n with acute, uncomplicated, falciparum malaria and may be an alternative t reatment for CQ- and/or SP-resistant falciparum malaria. Treatment with a C Q-CP combination (CQ and CP for 3 days and then CP alone for another 4 days ) is also effective but requires continuing administration after the signs and symptoms of acute malaria have disappeared.