COMPARATIVE STUDY OF EFFICACY OF CHLOROQUINE AND SULPHADOXINE PYRIMETHAMINE IN THE TREATMENT OF UNCOMPLICATED FALCIPARUM MALARIA IN CHILDREN

Abstract

This cohort, randomized clinical trial was carried out among 140 children
between the ages of 6 months and 5 years, using the World Health Organization
in-vivo 14-day test. The study was carried out from June 26 to October 21, 2003
in the paediatrics outpatient department of Ahmadu Bello University Teaching
Hospital, Zaria. Subjects were randomly allocated to chloroquine (71 children)
and sulphadoxine-pyrimethamine (69 children) groups. Each drug was
administered orally; chloroquine at a dose of 25mg/kg body weight over 3 days
and sulphadoxine-pyrimethamine at a single dose of 25mg/1.25 mg/kg body
weight. The patients were followed-up on DAYS 1,2,3,7 and 14. On each follow
up day patients were clinically examined and blood was taken for both
microscopic and haematological assessments.
The fever and symptom clearance times were similar in the two groups;
mean fever clearance time for chloroquine was 1.4 ± 1.09 days while that of
sulphadoxine-pyrimethamine was 1.6 ± 1.32 days (p = 0.31) and mean symptom
clearance time for chloroquine was 1.87 ± 0.65 days while that of sulphadoxine
pyrimethamine was 1.9 ± 0.84 days (p = 0.75). The parasite clearance time was
significantly shorter with sulphadoxine-pyrimethamine (2.05 ± 0.21 days) than
with chloroquine (2.34±0.74 days)(p<0.003). The clinical efficacy and
parasitological cure rates were higher with sulphadoxine-pyrimethamine (cure
rate of 97% and clinical efficacy of 97.1%) than with chloroquine (cure rate of
88.7% and clinical efficacy of 90.1%). Seven (9.9%) children with chloroquine
had treatment failure whilst 2 (2.9%) children developed sulphadoxine pyrimethamine failure. The haematocrit values in the two groups before and after
treatment were not significant stastically. The only adverse reaction observed
was pruritus in 7 children from the chloroquine group.
Overall, the findings of the present study suggest that sulphadoxine
pyrimethamine has a better therapeutic efficacy than chloroquine. The study also
showed that the efficacy of chloroquine is still high (90%) in the treatment of
acute, uncomplicated, plasmodium falciparum malaria in children, in Zaria.
Therefore this study agrees that CQ should still be used as first-line drug and
then followed by SP, as stipulated in the national policy on the guidance of
treatment of children with uncomplicated falciparum malaria.

COMPARATIVE STUDY OF EFFICACY OF CHLOROQUINE AND SULPHADOXINE PYRIMETHAMINE IN THE TREATMENT OF UNCOMPLICATED FALCIPARUM MALARIA IN CHILDREN