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Previous Volume 355:1959-1966 November 9, 2006 Number 19 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by White, N. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

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Conclusions Chloroquine is again an efficacious treatment for malaria, 12 years after it was withdrawn from use in Malawi.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 [ClinicalTrials.gov] .)

Source Information

From the University of Maryland School of Medicine, Baltimore (M.K.L., P.C.T., N.D.E., S.L.T., C.V.P.); the Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi (P.C.T., R.M., F.K.D., T.E.T.); and the College of Osteopathic Medicine, Michigan State University, East Lansing (T.E.T.).

Address reprint requests to Dr. Plowe at the Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore St., HSF1-480, Baltimore, MD 21201, or at cplowe{at}medicine.umaryland.edu.

Full Text of this Article

Related Letters:

Chloroquine-Resistant Malaria in Malawi
Kobbe R., Meyer C. G., May J., Ursing J., Rodrigues A., Kofoed P.-E., Muula A. S., Laufer M. K., Plowe C. V., Taylor T. E.
Extract | Full Text | PDF  
N Engl J Med 2007; 356:868-869, Feb 22, 2007. Correspondence

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