Predictors of chloroquine treatment failure in children and adults with falciparum malaria in Kampala, Uganda

Chloroquine-resistant falciparum malaria is a serious problem in much of su b-Saharan Africa. However, it is desirable to continue to use chloroquine a s first line therapy for uncomplicated malaria where it remains clinically effective. To identify predictors of chloroquine treatment failure, a 14-da y clinical study of chloroquine resistance in patients with uncomplicated f alciparum malaria was performed in Kampala, Uganda. Among the 258 patients (88% follow-up), 47% were clinical failures (early or late treatment failur e) and 70% had parasitological resistance (RI-RIII). Using multivariate ana lysis, an age less than five (odds ratio [OR] = 3.4, 95% CI = 1.8-6.3) and a presenting temperature over 38.0 degreesC (OR = 2.0, 95% CI = 1.1-3.7) we re independent predictors of treatment failure. In addition, patients who l ast took chloroquine 3 to 14 days prior to study entry were significantly m ore likely to be treatment failures compared to patients with very recent ( less than 3 days) or no recent chloroquine use. In areas with significant c hloroquine resistance, easily identifiable predictors of chloroquine treatm ent failure might be used to stratify patients into those for whom chloroqu ine use is acceptable and those for whom alternative treatment should be us ed.