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Title: Poor efficacy of antimalarial biguanide-dapsone combinations in the treatment of acute, uncomplicated, falciparum malaria in Thailand
Authors: P. Wilairatana
D. E. Kyle
S. Looareesuwan
K. Chinwongprom
S. Amradee
N. J. White
W. M. Watkins
Mahidol University
Walter Reed Army Institute of Research
Wellcome Trust Research Laboratories Nairobi
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Jan-1997
Citation: Annals of Tropical Medicine and Parasitology. Vol.91, No.2 (1997), 125-132
Abstract: Combinations of dapsone with proguanil or chlorproguanil have proved effective in the treatment of chloroquine-resistant falciparum malaria in Africa and for prophylaxis in Asia. These combinations have not been used for treatment in areas with multi-drug-resistant parasites such as in Thailand. Combinations of dapsone (approximately 4 mg/kg) plus either proguanil (approximately 8 mg/kg; DP regimen; N = 10) or chlorproguanil (approximately 1.4 mg/kg; DC regimen; N = 16) were given once a day for 3 days to adult Thai patients with acute, uncomplicated, falciparum malaria. The two regimens were well tolerated and had no side-effects, but the cure rates, assessed at 28-day follow-up, were only 10% for DP (60% with RI response and 30% with RII) and 14% for DC (29% with RI response and 57% with RII). The mean (S.D.) fever-clearance times in those patients who were cured (S) or whose infections recrudesced (RI response) were 103 (56) h for those given DP and 90 (42) h for those given DC. The corresponding parasite-clearance times were 83 (46) for DP and 53 (21) h for DC. In-vitro susceptibility testing of isolates obtained both before treatment and at recrudescence demonstrated marked resistance to cycloguanil, dapsone, chloroquine and mefloquine. The results demonstrate that short-course treatment with dapsone plus either proguanil or chloproguanil is ineffective for the treatment of falciparum malaria in Thailand.
ISSN: 00034983
Appears in Collections:Scopus 1991-2000

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