Effectiveness of short-course quinine and singledose sulfadoxine-pyrimethamine in the treatment of Plasmodium falciparum malaria in Mpumalanga province, South Africa

Introduction. Quinine therapy for 7 days remains the mainstay for treating hospitalised malaria cases in South Africa. However, limited resources, inc luding available beds and staff, often result in early discharge of non-sev ere cases, with quinine tablets for outpatient use. The effectiveness of sh orter course quinine therapy coupled with a long-acting antimalarial drug h as never been established in Africa, in particular in a population without malaria immunity. Methods. A study was conducted to evaluate the effectiveness of a 3-day cou rse of therapy with quinine sulphate (10 mg/kg 8-hourly) followed by a sing le dose of sulfadoxine-pyrimethamine (SP) according to weight category, bef ore discharge, for 133 hospitalised patients with uncomplicated Plasmodium falciparum malaria at Shongwe Hospital, Mpumalanga province, between Februa ry and July 1998. Study endpoints included clinical recovery and parasitolo gical cure, including polymerase chain reaction (PCR) 42 days after initiat ing treatment. Results. One hundred and thirty of 131 patients (99%) successfully followed up for 42 days demonstrated clinical and parasitological cure. The remaini ng patient, who had evidence of a recrudescent infection on PCR, was 1 of 6 1 patients who were still parasitaemic on discharge from hospital. Conclusion. The abbreviated course of quinine therapy coupled with a single dose of SP for the treatment of nonsevere hospitalised cases of Rfalcipari on malaria, in an area with demonstrated low levels of SP resistance, was h ighly effective. This approach has potential benefits, including reduced du ration of hospitalisation, fewer quinine-associated adverse events and prot ection against the evolution of quinine resistance by limiting unsupervised quinine therapy in the community. It may, however, be prudent to document a negative blood film before discharge from hospital.