Clinical experience with chloroquine-fansidar and quinine-fansidar combination in the treatment of malaria in the niger-delta region of Nigeria

Abstract

Multidrug resistant malaria is a topical issue with emphasis now on drug combination therapy to reduce and/or prevent fatalities resulting from malaria fever especially in the tropics. This study is our experience with drug combination therapy of presently available and affordable antimalarial drugs comparing them with single drugs both in terms of parasite clearance and symptomatic improvement of the patients.
We reviewed cases of malaria fever that were admitted and were on different treatment regimens of chloroquine alone; chloroquine + fansidar, quinine alone; quinine + fansidar. Malaria parasite count on admission, 48hrs and 72hrs post-treatment were evaluated using the QBC blood parasite detection methods. The temperature at admission, 6hrs, 12hrs and 24hrs were also recorded. Data were evaluated from 105patients. Twelve (12) patients were on chloroquine alone, 23 patients on chloroquine + fansidar, 20 patients on quinine alone and 50 patients on quinine + fansidar. Percentage parasite clearance after 48hrs were 42±32% for chloroquine, 54±22% for chloroquine + fansidar, 53±25% for quinine and 63±20% for fansidar + quinine. No significant difference in parasite clearance was noted between patients on chloroquine alone and chloroquine + fansidar; p=0.294 and also between quinine alone and quinine + fansidar; p=0.056. Similarly no significant parasite clearance exist between quinine and chloroquine monotherapy; p>0.05; however the parasite clearance of Fansidar and Quinine combination was significantly better than that of chloroquine alone, p<0.05. Though not statistically significant, three patients (25%) on chloroquine monotherapy had 0% parasite clearance at 48hrs compared to one patient (4.3%) on chloroquine + fansidar, p=0.07. One patient (5%) on quinine had 0% parasite clearance as against none in the quinine + fansidar group p=0.29. Quinine + fansidar combination offered no significant advantage over quinine alone in fever clearance either 6hrs or 24hrs post-treatment, 36.3±0.6 vs.36.2±0.70C; p=0.53 and 36.1±0.5 vs. 36.2±0.50C; p=0.41 respectively. Similarly no significant fever clearance was noticed with chloroquine + fansidar combination over chloroquine alone as monotherapy, 36.4 ±0.7 vs. 36.3±0.6; p=0.67 and 36.3±0.7 vs. 36.5±1.1; p=0.52. Even though no significant parasite clearance exist between drug combination of chloroquine + fansidar over chloroquine alone and quinine + fansidar over quinine alone, the degree of parasite clearance were better with the combination therapies .The side effects are comparable for both combination therapy and monotherapy treatment of malaria.

Keywords: Multidrug resistance, parasite elimination, combined therapy.

West African Journal of Pharmacology and Drug Research Vol. 21 (1&2) 2005: pp. 1-5