No abstract

Steroids from

La resistencia a medicamentos antimaláricos aumenta la carga de malaria en un país. En Colombia, la situación de los antimaláricos es apremiante dada la alta resistencia de Plasmodium falciparum a la cloroquina y la escasez mundial de amodiaquina. Ante este panorama, se evaluó la respuesta terapéutica a sulfadoxina/pirimetamina (SDXP) y cloroquina (CQ) como monoterapias y en combinación para el tratamiento de malaria no complicada por P. falciparum, aplicando el protocolo de OMS/OPS 1998, en Turbo y Zaragoza, dos municipios de Antioquia, Colombia. Se diseñó una muestra para grupos balanceados y los pacientes fueron asignados aleatoriamente a los grupos de tratamiento. Se evaluaron 160 pacientes con malaria por P. falciparum sin complicaciones. La distribución de pacientes de ambos municipios en cada grupo de tratamiento fue estadísticamente similar en la mayoría de variables. En Turbo hubo un porcentaje de falla terapéutica de 87,5% a CQ, 22,2% a SDXP y de 22,6% a la combinación, mientras en Zaragoza la falla terapéutica fue de 77% a CQ, 26,5% a SDXP y 12,1% a SDXP/CQ. Durante el seguimiento, 50% y 33,3% de los pacientes con falla terapéutica tardía en Turbo y Zaragoza, respectivamente, fueron asintomáticos. Este estudio encontró un alto nivel de falla terapéutica con CQ en ambos municipios, mientras la SDXP y la combinación mostraron niveles de falla cercanos al 25%. Es de anotar el hallazgo de pacientes con falla tardía parasitológica y el riesgo que significa esta situación en la permanencia de la transmisión.Palabras clave: cloroquina, sulfadoxina/pirimetamina, malaria, Plasmodium falciparum, falla terapéutica. Therapeutic efficacy of three treatment schemes in uncomplicated Plasmodium falciparum malaria in Antioquia, Colombia, 2002High resistance of Plasmodium falciparum malaria to chloroquine poses malaria as a major public health problem in Colombia. In this context, the therapeutic response of uncomplicated P. falciparum malaria patients to chloroquine (CQ), sulfadoxine/pirymethamine (SDXP) and combined therapy (SDXP/CQ) was evaluated according to the WHO/PAHO protocols of 1998. The comparisons were based on a sample of 160 patients with uncomplicated P. falciparum malaria in Turbo and Zaragoza (Antioquia, Colombia). Patients were randomly assigned each of the treatment categories. The results were statistically similar in each municipality. In Turbo percentage of treatment failure was 87.5%, 22.2% and 22.6% for CQ, SDXP and SDXP/CQ, respectively, whereas in Zaragoza, the corresponding treatment failure was 77.7%, 26.5% and 12.1%. During follow up, 50% of subjects with late treatment failure were asymptomatic in Turbo, while 33.3% were asymptomatic in Zaragoza. A high level of treatment failure occurred with CQ monotherapy, while SDXP and SDXP/CQ had acceptable levels of failure, i.e., below 25%. The high percentage of late treatment failure in asymptomatic patients may contribute to increased risk of persistent transmission.

Introduction: Sulfadoxine-pyrimethamine is an antimalarial used currently in worldwide for non-complicated falciparum malaria. This drug is administrated in combination with other ones. Previously adverse events had been reported with high doses, used in malaria prophylaxis and patients with hypersensibility to sulfas. Objetive: To evaluate hepatic and haematic toxicity of treatment with sulfadoxine-pyrimethamine (SP) in non-complicated falciparum malaria. Methodology: This was a non-blinded experimental design. In Turbo (Antioquia, Colombia), 17 subjects treated with SP were evaluated for liver and hematic function. All individual were followed for 10 days. Results: Before treatment, liver and hematic function tests were slight altedered. Hematic and liver variables returned to physiological levels after treatment. Treatment had 100% efficacy. All tests were within normal levels throughout the following period (postreatment); this suggests absence of toxic effects associates with treatment. Adverse effects were few and slight, and disappeared on day-10. Conclusions: When is used in time and dose for treatment of non-complicated falciparum malaria, SP neither increased adverse events nor hepatic or hematic toxicity.