Chemoprophylaxis of Homozygous Sicklers with Antimalarials and Long-acting Penicillin

A Randomized Trial to Compare the Safety, Tolerability, and Effectiveness of 3 Antimalarial Regimens for the Prevention of Malaria in Nigerian Patients With Sickle Cell Disease

“…Malaria prevention in SCD has, therefore, been considered to be essential in regions where malaria is endemic, but the evidence base for current drug policies, which rely mainly on daily proguanil therapy or weekly pyrimethamine or chloroquine therapy, is extremely weak. A Cochrane review of malaria prophylaxis for patients with SCD concluded that prophylaxis is beneficial, with fewer episodes of malaria, higher mean hemoglobin concentrations, fewer transfusions, fewer hospital admissions, and fewer sickle cell crises in patients receiving prophylaxis [ 6 ], but the review included only 2 small studies, one from Kampala in 1965, which involved administration of chloroquine plus benzathine penicillin for 12 months [ 7 ], and one from Nigeria in 2003, in which 97 patients were randomized to receive daily proguanil therapy, weekly pyrimethamine therapy, or placebo for 9 months [ 8 ]. Studies not in the review included a placebo-controlled trial of 60 patients in Senegal that showed that monthly sulfadoxine-pyrimethamine (SP) treatment during the transmission season was well tolerated and reduced morbidity [ 9 ]; a study in Uganda, with just 1 month of follow-up, that suggested that weekly chloroquine therapy was less effective than monthly SP therapy [ 10 ]; and a study in Nigeria that indicated that weekly mefloquine (MQ) was well tolerated and more effective than daily proguanil [ 11 ].…”

Systematic review of current and emerging strategies for reducing morbidity from malaria in sickle cell disease

“…While the sample size was small, leaving the study seriously underpowered (24 subjects), there was a trend towards lower rates of death and sickle cell crises among those who received prophylaxis vs. the control group (RR 0.24, 95% CI 0.03-1.7). In a similar study assessing the combined effect of benzathine penicillin and chloroquine, Warley et al (1965) found significantly reduced rates of malaria parasitaemia and anaemia, as well as reduced incidence of dactylitis, one of the more common manifestations of sickle cell crises: 1.8 episodes per intervention child vs. 5.2 attacks in the control children. More recently, Diop et al (2011) in Senegal have demonstrated a reduction in the need for blood transfusion in patients with SCD on SP prophylaxis compared with those who received placebo; no differences were seen in rates of vaso-occlusive crises, although their ability to detect these endpoints may have been limited by the sample size of sixty subjects followed for at most 4 months.…”

“…In a similar study assessing the combined effect of benzathine penicillin and chloroquine, Warley et al . () found significantly reduced rates of malaria parasitaemia and anaemia, as well as reduced incidence of dactylitis, one of the more common manifestations of sickle cell crises: 1.8 episodes per intervention child vs . 5.2 attacks in the control children.…”

Presumptive treatment with sulphadoxine-pyrimethamine versus weekly chloroquine for malaria prophylaxis in children with sickle cell anaemia in Uganda: a randomized controlled trial

“…In Uganda, chloroquine chemoprophylaxis was first used in 1962 where it significantly reduced malaria incidence by 43% [ 7 , 10 ]. While chloroquine resistance was negligible then, in the recent past it has become unacceptably high ranging from 60 to 80% [ 7 , 11 , 12 ].…”