The comparative efficacy of chloroquine and sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in Kampala, Uganda

Chloroquine (CQ) remains the first-line treatment for uncomplicated malaria in much of Africa despite the growing problem of resistance to this drug. Sulfadoxine-pyrimethamine (SP) is often used after CQ treatment failure and has replaced CQ as the first-line treatment in parts of Africa. To compare the efficacy of these 2 regimens, we evaluated, in March-August 1999, clin ical and parasitological responses over 28 days in 214 children and adults from Kampala, Uganda, with uncomplicated falciparum malaria. Compared to SP , significantly more patients treated with CQ developed early or late clini cal failure (54% vs 11%, P < 0.001) and parasitological failure (72% vs 30% , P < 0.001) during 14 days of follow-up. The risk of treatment failure occ urring after day 14 was similar between the 2 treatment groups. Among those treated with CQ, children aged < 5 years were at higher risk of clinical f ailure than older individuals (76% vs 28%, P < 0.001), an association not s een with SP (11% vs 10%, P = 0.91). Although early parasite clearance was s ignificantly better in the SP group (P = 0001), fever clearance at day 3 wa s the same (CQ 85%, SP 86%). These and other recent findings suggest that c onsideration be given to replacing CQ as the first-line therapy for uncompl icated malaria in Uganda, particularly in young children.