A Comparative Trial of Three Regimens for Treating Uncomplicated Falciparum Malaria in Acre, Brazil

Quinine plus clindamycin improves chemotherapy of severe malaria in children

“…As clindamycin is a slowly acting antimalarial agent, it should be used as a single agent only for treating semi-immune malaria patients (3). However, combined with the fast-acting quinine, it enhanced parasite clearance, as shown in the present study and in previous trials involving patients with uncomplicated P. falciparum malaria (4,5). From these studies, it became obvious that not only the antiparasitic activity of clindamycin but also other properties, including its possible antibacterial effect, may be of value in the treatment of severe malaria.…”

“…The use of clindamycin in combination with quinine for treating human volunteers with chloroquine-resistant malaria was first described two decades ago (7). In comparative trials, clindamycin combined with quinine improved the cure rate of uncomplicated P. falciparum malaria for patients in Africa and South America (4)(5)(6). On the basis of this rationale, we have compared the 7-day quinine regimen with a 4-day quinineclindamycin regimen for treating Gabonese children with severe malaria.…”

Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase of isolates from the Amazon Region of Brazil

“…After one decade with continued wide availability and use of the drug, 92% of the samples collected from the State of Acre in 1987 were found to be PS resistant. Proguanil was never introduced in Brazil and no current information is available on the in vitro efficacy against Brazilian isolates of cycloguanil, the active metabolite of proguanil (Kremsner et al 1989, Neifer & Kremsner 1991.…”

Antimalarial drug susceptibility testing of Plasmodium falciparum in Brazil using a radioisotope method

“…In vitro studies in Brazil have been conducted using morphology-techniques (Alecrim 1986, Di Santi et al 1988, Kremsner et al 1989). These techniques are less expensive than the radiosotopic ones, but are also more prone to subjective misinterpretation.…”

“…Malaria prevalence in Brazil has increased three times during the past and quinine in those studies were too low, leading to overestimation of the resistance percentages (Alecrim 1986, Di Santi et al 1988) When adequate "cut off" limits are employed, taking together in vivo and in vitro data, parasite resistance has been observed at levels greater than 70% to chloroquine, greater than 60% to sulfadoxine-pyrimethamine, lower than 20% to quinine and almost none to mefloquine (Boulos et al 1986, Alecrim 1986, Di Santi et al 1988, Kremsner et al 1989, Souza 1992, Couto et al 1993. As in vitro evaluations of P. falciparum sensitivity have not been performed since the 80's (Di Santi et al 1988, Kremsner et al 1989, and considering that radioisotopic methods had not been used, except in one occasion (Zalis et al 1998), we decided to verify the patterns of resistance in a typical endemic area of the Brazilian Amazon region.…”