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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and eighteen patients with acute falciparum malaria were randomized into treatment with either intramuscular or oral sulfadoxine-pyrimethamine (Fansidar, Roche) and the results were compared with those from 68 patients treated in parallel with chloroquine. Parasitological cure rate was 97% with oral sulfadoxine-pyrimethamine, 95% with the injection, and only 63% with chloroquine. The time for the disappearance of parasitaemia in sensitive cases was the same with oral and intramuscular sulfadoxine-pyrimethamine and shorter than with chloroquine. Side effects occurred in only 3 of the patients treated with intramuscular sulfadoxine-pyrimethamine compared with 8 of those treated with the tablets and 13 of those treated with chloroquine. The results showed that intramuscular sulfadoxine-pyrimethamine is as effective as, and probably better tolerated than, the oral drug. Increasing failure of response to chloroquine in Nigeria was also demonstrated.
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PMID:Parenteral sulphadoxine-pyrimethamine (Fansidar): an effective and safe but under-used method of anti-malarial treatment. 175 76

In the last 2 years, there has been public panic across Nigeria about an epidemic of a 'killer' febrile disease, purportedly typhoid fever. The evidence for this epidemic is reviewed in the light of appropriate diagnosis of typhoid fever. All the patients were diagnosed as typhoid fever, primarily based on Widal test results. Investigations in the hospital of 15 patients confirmed malaria in 70% who, though failing to respond to chloroquine, promptly responded to treatment with Fansidar (sulfadoxine + pyrimethamine). Fever in the remaining 30%, without evidence of malaria and who failed to respond to chloroquine, Fansidar and antibacterials including chloramphenicol, remitted spontaneously. The merits and limitations of the Widal test are discussed. It is concluded that diagnosis of typhoid fever by the Widal test alone is prone to error, and that any claims of a typhoid fever epidemic in Nigeria remain mere conjecture. Misuse of the Widal test and, subsequently, misuse of the antibiotic chloramphenicol, should be very strongly condemned.
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PMID:Diagnosis of typhoid fever in Nigeria: misuse of the Widal test. 206 45

The plasma concentrations of sulfadoxine, pyrimethamine, mefloquine and its major metabolite were determined in 18 healthy male volunteers who had regularly taken either 500 mg of sulfadoxine and 25 mg of pyrimethamine (Fansidar) weekly or 250 mg mefloquine regularly every 14 d during 6 months for malaria prophylaxis. The mean trough concentrations of sulfadoxine, pyrimethamine and mefloquine were 194, 0.28 and 1.48 mumol/litre and the mean half lives were 7.7, 4.2 and 25 d respectively. The variation in area under the curve for the 3 drugs was only 2-3 fold. The findings do not indicate that drug accumulation or induction of metabolism occurred during long-term usage.
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PMID:Plasma concentrations of sulfadoxine-pyrimethamine and of mefloquine during regular long term malaria prophylaxis. 234 26

The A.A. weight present criteria of choice in order to set right a correct and effective anti-malarial prophylaxis. In the last ten years, a progressive increase of tropical diseases has been observed. This is due to the considerable growth of intercontinental traffic and of the number of persons moving to or from tropical areas where such diseases are endemic. Among these, malaria represent the most alarming problem, both because of the incidence cases and the difficulties related to the efficacy of pharmacological remedies for the chemoprophylaxis. In particular, three are now various pharmacological possibilities for malarial prophylaxis. Undoubtedly Chloroquine is the most efficacious even if there are many Plasmodium falciparum species resistant to Chloroquine and to other available medicines (multi-resistance). Most authors recommend to associate Chloroquine to others pharmacological substances to avoid pharmaco-resistance phenomena. Among the most famous pharmacological products used elsewhere are Fansidar, Maloprim, Paludrine and Lapudrine, not all are available in Italy. In China, for the therapy of resistant forms of malaria, the Qinghaosu a "schizont-killer" acting on multiresistant plasmodium falciparum has been utilizing for years. The Qinghaosu is not responsible for the crossing-reactions with other anti-malarial medicines. Various substances with Ca-antagonist action (Verapamil) are being experimented. It is supposed that Verapamil associated with Chloroquine can stop the flow of chlorine from plasmodium cells. The same mechanism is expected to be valid also for Desipramine, an experimental tricyclic anti-depressive when associated to Chloroquine. To the people moving to endemic areas, the A.A., at the end, suggest a series of practical norms to prevent infection and, therefore, the incidence of imported cases, still increasing at the moment, due to the absence of efficacious vaccine.
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PMID:[A current problem: the prevention of malaria]. 248 2

Forty cases of imported malaria (1978 to 1988) are reviewed and management principles are discussed. All 15 cases of Plasmodium falciparum malaria were acquired in Africa, 5 of which were probably chloroquine-resistant. Most cases of Plasmodium vivax (80%) were acquired on the Indian subcontinent, including 2 cases of congenital malaria. Six children developed P. falciparum malaria despite chemoprophylaxis. All children had a history of fever, usually with other influenza-like symptoms. Two-thirds had splenomegaly, and one-third were afebrile on admission. Thrombocytopenia (70%) and anemia (70%) were often present. Forty-five percent received previous wrong diagnoses and treatments. Quinine or quinidine with either Fansidar or clindamycin were used to treat P. falciparum malaria. Clindamycin may be more effective if given for 7 instead of 3 days. There were no deaths or residual complications. As the prevalence and severity of drug-resistant P. falciparum spreads, prophylaxis and treatment choices become more difficult. Diagnosis requires a travel history and a high index of suspicion.
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PMID:Review of 40 children with imported malaria. 259 48

Selective age group treatment and village scale chemotherapeutic malaria control operation were carried out in east-coast villages in North Sumatra, Indonesia in 1987/1988. A single dose of Fansidar plus primaquine was adopted as the drug regimen to cut the transmission of malaria at the gametocyte stage. After the treatment on day seven, the gametocyte positive rate was reduced to only 2.7% in 72 Plasmodium falciparum gametocyte carriers. A significant reduction of P. falciparum prevalence in the community was observed after successive selective age group treatment in primary school, however P. vivax prevalence persisted. Village scale active case detection was carried out by one health center staff and two village health volunteers. After eight months P. falciparum prevalence was reduced from 14% to 1%. As the result of the chemotherapeutic control activities covering high-prevalence villages in the coastal area, malaria prevalence in 1988 became very low, as compared with the status in 1985/1986.
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PMID:Chemotherapeutic malaria control operation by single dose of Fansidar plus primaquine in North Sumatra, Indonesia. 263 46

The spread of chloroquine resistant strains of P. falciparum requires new approaches to treatment especially in tropical Africa. A single dose of 3 tablets of sulfadoxine-pyrimethamine (Fansidar) is a suitable and relatively inexpensive alternative. But under drug pressure resistance to this compound has developed in some South-East Asian countries and in Brazil, giving rise to multiple resistant strains of P. falciparum. A similar pattern has arisen with quinine to which almost 50% of P. falciparum strains have become resistant in Thailand. However the combination treatment of quinine with tetracycline given for 7 days is still successful in most cases. Unfortunately compliance to this regimen is rather poor in out-patients. Mefloquine (Lariam), recently marketed, and if used as 750 mg dose in semi-immune adult patients weighing less than 60 kg, has made possible a single-dose treatment schedule for falciparum malaria. In controlled studies conducted in South-East Asia the success rate of mefloquine was 97% in 445 patients. Since there is some fear of the appearance of resistance of P. falciparum to mefloquine, a combination of this compound with sulfadoxine and pyrimethamine was developed (MSP or Fansimef). Various controlled studies in South-East Asia have shown a success rate of this compound of 97% in 278 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The treatment of multiresistant falciparum malaria in Southeast Asia]. 266 11

In the North Fly region of the Western Province of Papua New Guinea 491 cases of Plasmodium falciparum infection were monitored in vivo for sensitivity to chloroquine and amodiaquine over a 2-year period; 41% resistance was detected. The RI type accounted for 74% of the resistant strains detected; 43% of these recrudesced on day 28 or shortly thereafter. 22% of resistant strains were RII type and 4% R III. The infections were categorized as imported or locally acquired. Imported infections accounted for 58% of the cases monitored and showed a resistance rate of 49%. Resistance was detected in 24% of the cases indigenous to the North Fly region (13% in the Kiunga-Ningerum area and 38% in the Ok Tedi-Star Mountains area). Linguistic groups immediate to the Ok Tedi mining operation, the Wopkaimin and Kamfaiwolmin, showed an increase in resistance from 28% in 1986 to 55% the following year. This increase was associated with renewed construction activity within the mine's development area. Two falciparum malaria outbreaks were experienced during this study, the second being attributed to introduced strains. The study showed the impact of age and variation of malaria endemicity in suppressing resistance. The study also demonstrated a possible cross-resistance problem between imported cases of P. falciparum treated with amodiaquine and chloroquine, with resistance rates of 58% and 60%, respectively, demonstrated in children under 10 years of age. The 61% amodiaquine resistance rate in locally acquired infection in children was attributed to drug pressure, since chloroquine resistance in the same group was reported at 19%. RIII-type resistance in children was only detected in those treated with amodiaquine. The efficacy of amodiaquine in clearing only 41% of the P. falciparum infections in children was a major concern. All 201 resistant P. falciparum infections detected over the 24-month monitoring period responded to treatment with quinine and Fansidar.
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PMID:Resistance of Plasmodium falciparum to chemotherapy with 4-aminoquinolines in the Ok Tedi area of Papua New Guinea. 266 76

The sulfadoxine-pyrimethamine combination has not been recommended for the prophylaxis of malaria since 1985 following serious accidents in the USA. However, this drug is worth considering for treatment since it has the advantage over mefloquine of being cheaper, having fewer side effects and it avoids using mefloquine. A study of Plasmodium falciparum resistance to Fansidar should be carried out on cases imported to France to determine an adapted utilisation of this drug. This would be an appreciable advantage for tropical Africa.
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PMID:[Plasmodium falciparum drug resistance and sulfadoxine-pyrimethamine in Africa]. 267 Feb 91

From March 1981 until August 1985, 79 children suffering from falciparum malaria were treated with chloroquine upon admission to the Department of Child Health, Medical School Sam Ratulangi University/Gunung Wenang General Hospital, Manado. Twenty-one out of 79 patients were within range of the criteria of resistance as established by WHO: Standard field test or 7 days test. Six (28.6%) out of 21 patients belonged to resistance II (R II) to chloroquine. The duration of fever in the 6 patients with R II to chloroquine was 2-7 days, with the average of 3.3 days. Patients with R II to chloroquine were treated with Fansidar, and all of them were cured.
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PMID:Chloroquine resistant falciparum malaria in children. 267 20


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