Cotrimoxazole in the treatment of acute uncomplicated falciparum malaria in Nigerian children - A controlled clinical trial

Objectives: To evaluate the efficacy of cotrimoxazole in the treatment of Plasmo-dium falciparum malaria and to compare the efficacy of cotrimoxazole with that of pyrimethamine-sulfadoxine, a second-line antimalarial drug, in an area of high malaria transmission. Patients and methods: Children aged between 10 months and 10 years with clinical and parasitological evidence of P. falciparum malaria were randomised to receive either cotrimoxazole or pyrimethamine-sulfadoxine. 145 children (73 and 72, respectively, in the cotrimoxazole and pyrimethamine-sulfadoxine groups) completed the study per protocol and were evaluated. Results: Pretreatment clinical and parasitological parameters were similar in the two treatment groups. The time to clear fever and other symptoms was similar in the two groups: 1.94 +/- 1.10 days versus 2.20 +/- 0.96 days, p > 0.05. Parasite clearance times were also similar: 2.62 +/- 0.91 days versus 2.94 +/- 1.17 days, respectively, for cotrimoxazole and pyrimethamine-sulfadoxine; p > 0.05. The cure rates on days 14, 21 and 28 were; respectively, 84.9, 75.3 and 74.0% for the cotrimoxazole group and 84.7, 80.5 and 75.0% for the pyrimethamine-sulfadoxine group. Both drugs were well tolerated. Conclusions: These results indicate that cotrimoxazole has similar efficacy to pyrimethamine-sulfadoxine in the treatment of acute uncomplicated P. falciparum malaria in children resident in an endemic area of Southwest Nigeria.