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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Return of chloroquine antimalarial efficacy in Malawi
New England Journal of Medicine, Volume 355, No. 19, Year 2006
Notification
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Description
BACKGROUND: In 1993, Malawi became the first country in Africa to replace chloroquine with the combination of sulfadoxine and pyrimethamine for the treatment of malaria. At that time, the clinical efficacy of chloroquine was less than 50%. The molecular marker of chloroquine-resistant falciparum malaria subsequently declined in prevalence and was undetectable by 2001, suggesting that chloroquine might once again be effective in Malawi. METHODS: We conducted a randomized clinical trial involving 210 children with uncomplicated Plasmodium falciparum malaria in Blantyre, Malawi. The children were treated with either chloroquine or sulfadoxine-pyrimethamine and followed for 28 days to assess the antimalarial efficacy of the drug. RESULTS: In analyses conducted according to the study protocol, treatment failure occurred in 1 of 80 participants assigned to chloroquine, as compared with 71 of 87 participants assigned to sulfadoxine-pyrimethamine. The cumulative efficacy of chloroquine was 99% (95% confidence interval [CI], 93 to 100), and the efficacy of sulfadoxine -pyrimethamine was 21% (95% CI, 13 to 30). Among children treated with chloroquine, the mean time to parasite clearance was 2.6 days (95% CI, 2.5 to 2.8) and the mean time to the resolution of fever was 10.3 hours (95% CI, 8.1 to 12.6). No unexpected adverse events related to the study drugs occurred. CONCLUSIONS: Chloroquine is again an efficacious treatment for malaria, 12 years after it was withdrawn from use in Malawi. (ClinicalTrials.gov number, NCT00125489.) Copyright © 2006 Massachusetts Medical Society.
Authors & Co-Authors
Laufer, Miriam K.
United States, Baltimore
University of Maryland School of Medicine
Thesing, Phillip C.
United States, Baltimore
University of Maryland School of Medicine
Malawi, Zomba
University of Malawi
Eddington, Nicole D.
United States, Baltimore
University of Maryland School of Medicine
Masonga, Rhoda
Malawi, Zomba
University of Malawi
Dzinjalamala, Fraction K.
Malawi, Zomba
University of Malawi
Takala, Shannon L.
United States, Baltimore
University of Maryland School of Medicine
Taylor, Terrie Ellen
Malawi, Zomba
University of Malawi
United States, East Lansing
Msu College of Osteopathic Medicine
Plowe, Christopher Vv
United States, Baltimore
University of Maryland School of Medicine
Statistics
Citations: 428
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1056/NEJMoa062032
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Study Locations
Malawi