title: Antipyretic, parasitologic, and immunologic effects of combining sulfadoxine/pyrimethamine with chloroquine or paracetamol for treating uncomplicated Plasmodium falciparum malaria.
abstract: Sulfadoxine/pyrimethamine (SP) is increasingly used against malaria in sub-Saharan Africa because of chloroquine resistance. However, chloroquine may have a beneficial antipyretic effect. We therefore compared the combination of SP plus chloroquine, chloroquine alone, SP alone, and SP plus paracetamol in the treatment of uncomplicated Plasmodium falciparum malaria in 175 Tanzanian children (1-4 years old) in a randomized trial. Outcome variables were axillary temperatures every six hours, daily parasitemias, and serum levels of IgG antibodies to P. falciparum. Lower mean temperatures (6-48 hours) were achieved with SP plus chloroquine or paracetamol than with SP alone (P < 0.001) or chloroquine alone (P < 0.05). All three SP-treated groups showed high and similar parasite reduction (0-48 hours), whereas treatment with chloroquine alone was much less effective. Levels of IgG antibodies to P. falciparum increased significantly (P < 0.001) and similarly in the four treatment groups between days 0, 2, and 3. Thus, the addition of chloroquine or paracetamol to SP improved the clinical outcome, but did not affect the parasitologic response or antibody production.
authors.affiliation: Malaria Research Unit, Division of Infectious Diseases, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden. ehugosson@hotmail.com
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hugosson
authors.forename: Donath
authors.initials: D
authors.lastname: Tarimo
authors.forename: Marita
authors.initials: M
authors.lastname: Troye-Blomberg
authors.forename: Scott M
authors.initials: SM
authors.lastname: Montgomery
authors.forename: Zul
authors.initials: Z
authors.lastname: Premji
authors.forename: Anders
authors.initials: A
authors.lastname: Björkman
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage*; D001831:Body Temperature / Q000187:drug effects; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage*; D004338:Drug Combinations; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008297:Male; D010963:Plasmodium falciparum; D011739:Pyrimethamine / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013413:Sulfadoxine / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000962:Antimalarials; D004338:Drug Combinations; D007074:Immunoglobulin G; D000082:Acetaminophen; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine