Antipyretic, Parasitologic, and Immunologic Effects of Combining Sulfadoxine/Pyrimethamine With Chloroquine or Paracetamol for Treating Uncomplicated Plasmodium Falciparum Malaria

Abstract

Abstract. Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1−4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6−48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0−48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2. and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.

Randomized Comparison of Chloroquine plus Sulfadoxine-Pyrimethamine versus Artesunate plus Mefloquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Falciparum Malaria in the Lao People's Democratic Republic

“…The mean times for fever and parasite clearance were shorter in patients treated with chloroquine plus sulfadoxine-pyrimethamine ( [3]. The shorter fever clearance time associated with chloroquine plus sulfadoxine-pyrimethamine, compared with sulfadoxine-pyrimethamine treatment alone, may reflect an antipyretic effect of chloroquine [33] or earlier stage specificity of chloroquine's activity.…”

Reduction of Malaria Transmission to Anopheles Mosquitoes with a Six-Dose Regimen of Co-Artemether

“…A non-artemisinin combination under consideration in a number of African countries is CQ/SP, largely due to its low cost [17]. In The Gambia, where CQ has been front-line treatment policy up until 2004, clinical treatment failures with CQ monotherapy are approaching 20% in in vivo tests of drug efficacy [11].…”

Biological Resistance of Hydroxychloroquine for Plasmodium vivax Malaria in the Republic of Korea

“…This slow clearance may indicate the beginning of drug resistance to HCQ. 22,23 Although CQ can have a antipyretic effect, 24 none of the volunteers were readmitted to the hospital for fever within 28 days after therapeutic medication, except for one patient that was diagnosed with malaria (relapse) 31 days post-treatment. In this case, a recurrence of malaria cannot Table 3 The whole blood concentrations of total hydroxychloroquine for eight malaria patients with THCQ pre-drug levels > 100 ng/mL at D0 (pretreatment) and that also reported chemoprophylaxis compliance* * HCQ = hydroxychloroquine; DHCQ = desethylhydroxychloroquine; THCQ = total hydroxychloroquine (HCQ + DHCQ) .…”