COMPARISON OF INTRAMUSCULAR SULFADOXINE-PYRIMETHAMINE AND INTRAMUSCULAR QUININE FOR THE TREATMENT OF FALCIPARUM-MALARIA IN CHILDREN

The efficacy of intramuscular (i.m.) sulfadoxine-pyrimethamine (sulfadoxine 25 mg/kg plus pyrimethamine 1.25 mg/kg in a single dose; n = 48) was compared with that of i.m. quinine (10 mg/kg 8-hourly for at least 3 d followed by oral quinine to complete 7 d; n = 54) in children with severe malaria without life-threatening complications in Maputo Central Hospital, Mozambique in 1989. Mean parasite clearance time and mean fever clearance time were 55.4 h and 48.1 h, respectively, in the sulfadozine-pyrimethamine group, and 60.7 h and 54 h in the quinine group. Seven cases in the sulfadoxine-pyrimethamine group were RII/RIII resistant compared with none in the quinine group, but parasite reduction during the first 48 h was no slower in the resistant cases than in the 7 poorest responders to quinine. Blood sugar levels were slightly, but not significantly, lower in the quinine group. On day 7, leucocyte counts were significantly lower in the sulfadoxine-pyrimethamine group, but within the normal range. It is concluded that a single dose of sulfadoxine-pyrimethamine may be useful for the treatment of complicated malaria at health care units without facilities for admission, or if transferral is necessary after start of treatment.