Amodiaquine and sulfadoxine-pyrimethamine as treatment for chloroquine-resistant Plasmodium falciparum in Rwanda

The efficacy of amodiaquine and sulfadoxine-pyrimethamine combination as a second-line therapy for chloroquine-resistant Plasmodium falciparum infections was investigated in Rwanda in September 1986. Children less than or equal to 5 years old presenting with a P. falciparum parasitemia 14 days after treatment with chloroquine were administered either amodiaquine (25 mg/kg over 3 days, 64 patients) or sulfadoxine-pyrimethamine (as a single dose with tablets containing 500 mg of sulfadoxine and 25 mg of pyrimethamine: 1/4 tablet for children under 1 year, 1/2 for those 1-3 years old, and 1 tablet for those 4-5 years old; 34 patients) and followed for 7 days. Seven days after starting treatment with amodiaquine, 50 (76%) children were aparasitemic. All the children who had received sulfadoxine-pyrimethamine were aparasitemic 7 days after initiation of therapy.

[Complications of closed chest injuries]

The role of predisposing factors in the development of complications in 1533 patients with closed traumas of the chest was studied as well as the dynamics of the state of the system of humoral regulation of microcirculation. The factors predisposing to the development of complications are the age older than 40, hospitalization later than 1 day from the trauma, double fractures of the ribs, injuries of lungs, hemothorax, concomitant diseases. In all the patients there was a subacute syndrome of disseminated intravascular coagulation, activation of the Kallikrein-Kinin system and inhibition of the complement system.

Comparative efficacy of alternative primary therapies for Plasmodium falciparum infections in Malawi

In Malawi, where high levels of chloroquine resistance were shown using a modified 7-day in vivo test, amodiaquine and pyrimethamine-sulfadoxine were evaluated as alternative initial therapies for Plasmodium falciparum infections in children under 5 years old. Therapy success rates, judged by parasite clearance by day 7 after initiation of therapy, were significantly greater among 39 children treated with amodiaquine at 10 mg/kg (90%), 37 receiving amodiaquine at 25 mg/kg (97%), and 34 receiving pyrimethamine-sulfadoxine (100%) at a dose of 25 mg sulfadoxine/kg, than among those treated with chloroquine at a dose of 25 mg/kg (59%) (P = 0.01). Extension of the follow-up period of those receiving amodiaquine (25 mg/kg) and pyrimethamine-sulfadoxine to 21 d revealed a progressively increasing rate of parasite recrudescence in the amodiaquine group (34%), but no recrudescence in the pyrimethamine-sulfadoxine group. These results suggest that, in Malawi, amodiaquine and pyrimethamine-sulfadoxine are superior to chloroquine in producing prompt clearance of P. falciparum parasites among young children, and that pyrimethamine-sulfadoxine alone is superior to the 4-aminoquinolines in sustaining P. falciparum clearance.

Response of Plasmodium falciparum infections to pyrimethamine-sulfadoxine in Thailand

The results of this study in Thailand indicate that the early response of falciparum infections to a single dose of pyrimethamine-sulfadoxine is influenced by the developmental stages of the parasite present at the time of treatment. Parasite clearance is slower when young rings predominate at the time of treatment. This should be taken into account when considering the clinical management of patients and the comparative efficacy of antimalarials in clearing parasites from the peripheral blood. The 36-48 hr delay in schizonticidal action observed after treatment of febrile infections and the associated decline in blood concentrations of pyrimethamine suggest that a single dose may not be the ideal way of administering this drug combination and may encourage the emergence of drug-resistant parasites.

Kelfiprim versus co-trimoxazole in recurrent and persistent urinary tract infections: multicenter double-blind trial

Kelfiprim (KP) is a new bactericidal agent containing trimethoprim (T) and sulfametopyrazine (S), a long-acting sulfonamide (ratio 5:4). The posology is one capsule (T 250 mg + S 200 mg) daily, after a loading dose of two capsules on the first day. To evaluate the clinical value of Kelfiprim (KP) vs co-trimoxazole (CO) in urinary tract infection (UTI) a controlled multicenter double-blind trial (MDBT) was carried out in 76 patients suffering from persistent and recurrent UTIs. About 90 per cent response rate (sterile urine at the end of treatment) was obtained for KP and about 85 per cent for CO in recurrent UTI. In persistent UTI the rate of recovery was 66.8 per cent and 53 per cent for KP and CO, respectively. Safety of treatments was excellent in 97 per cent of patients treated with Kelfiprim and 87 per cent treated with co-trimoxazole. Two patients, one in each group, were dropped from the study because of adverse reactions.

Efficacy of malaria prophylaxis in American and Swiss travelers to Kenya

The protective effect of malaria chemoprophylaxis with either Fansidar (pyrimethamine-sulfadoxine) or chloroquine was estimated by determining the attack rates of Plasmodium falciparum infections acquired in Kenya and imported by U.S. and Swiss travelers who had used no chemoprophylaxis, who had used only chloroquine for prophylaxis, and who had used Fansidar weekly, either alone or in combination with chloroquine. The estimated attack rates were almost identical in U.S. and Swiss travelers. The attack rate per 100,000 travelers averaged 280 in those who did not use chemoprophylaxis, 162 in those who took 4-aminoquinolines (P greater than .05), and 27 in those who used Fansidar for prophylaxis (P less than .001). Non-immune travelers to Kenya have an appreciable risk of acquiring a P. falciparum infection and need to be informed of current guidelines for chemoprophylaxis. The changing drug susceptibility patterns in Africa require continuous evaluation of the efficacy of recommended drug regimens for malaria prophylaxis.

The effect of mefloquine-sulfadoxine-pyrimethamine vs quinine on patients with complicated falciparum malaria

Sixty-six patients with complicated falciparum malaria (defined as anaemia, hyperpyrexia, jaundice, or more than 2% of RBC parasitised) were studied. Patients with cerebral signs and symptoms were not included in the study. Patients were randomised in pairs to receive either mefloquine 750 mg, sulfadoxine 1500 mg and pyrimethamine 75 mg (MSP) single oral dose or quinine (10 mg/kg tds X 7 days oral therapy). All the patients were admitted in hospital for 7 days and were followed on days 14, 21 and 28. All patients survived. The parasite clearance times in MSP treated patients were significantly shorter then those treated with quinine. There was no difference in fever clearance time in the two groups of patients. One patient was resistant to MSP at RII level and 5 patients were resistant at RI level. Among patients treated with quinine 3 patients were resistant at RI level.

Use of pyrimethamine-sulfadoxine (Fansidar) in prophylaxis against chloroquine-resistant Plasmodium falciparum and Pneumocystis carinii

The widespread emergence of chloroquine-resistant Plasmodium falciparum led to the formulation of an effective, fixed combination of two antimalarial agents, pyrimethamine and the long-acting sulfonamide sulfadoxine, for prophylaxis and treatment. These drugs act at sequential steps to inhibit the formation of tetrahydrofolate in the parasite. Recently, their use for malaria prophylaxis has been associated with severe, at times fatal, cutaneous reactions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. These reactions have necessitated a major reassessment of the indications for pyrimethamine-sulfadoxine use and increased the search for pharmacologic, immunologic and behavioral approaches to the prophylaxis and treatment of infection with P. falciparum. Pyrimethamine-sulfadoxine may be effective in preventing recurrent pneumonia caused by Pneumocystis carinii in patients with the acquired immunodeficiency syndrome, but life-threatening cutaneous reactions have also been reported in this setting.

Plasma and whole blood mefloquine concentrations during treatment of chloroquine-resistant falciparum malaria with the combination mefloquine-sulphadoxine-pyrimethamine

Mefloquine-sulphadoxine-pyrimethamine (MSP) in combination has proved effective against multiple-drug-resistant falciparum malaria, but nothing is known about mefloquine absorption when it is given in this formulation. Nine Thai patients, aged 15-51 years with uncomplicated chloroquine-resistant falciparum malaria, took 11.2-16.7 mg of mefloquine base per kilogram bodyweight as MSP tablets. All patients responded to treatment with fever and parasite clearance times of 61 +/- 29 h (mean +/- s.d.) and 52 +/- 24 h, respectively. The mean apparent absorption half-time (t1/2abs) of mefloquine was 4.89 h (range 2.25-9.72) and mean peak plasma concentration was 1815 ng ml-1 (range 725-3368). Peak plasma mefloquine concentrations in three patients who vomited within 2 h of treatment were 725, 956 and 1972 ng ml-1. There was no significant difference between plasma and whole blood mefloquine concentrations during the first 48 h of treatment. Based on the elimination of parasitaemia, the plasma mefloquine concentrations are adequate for therapy of uncomplicated falciparum malaria although the relationship between plasma concentrations and therapeutic efficacy of mefloquine requires further study.

[In vivo resistance of Plasmodium falciparum to 4-aminoquinolines and to a sulfadoxine-pyrimethamine combination. II--The Emperatriz study, Maranhâo, 1983-1984]

Através da prova de 7 dias foram estudadas as respostas terapêuticas de 96 pacientes com malária falciparum não grave atendidos pela SUCAM em Imperatriz, Maranhão. Esses pacientes foram distribuídos aleatoriamente em três grupos de estudo, tendo o primeiro recebido cloroquina, o segundo amodiaquina e o terceiro a associação sulfadoxina-pirimetamina. Mesmo sem evidenciar significância estatística ao nível de 5% de probabilidade, as diferenças observadas nas respostas as 3 drogas apontam para a associação sulfadoxina-pirimetamina como a que produziu melhores resultados terapêuticos. Recomenda-se a monitorização contínua da resistência nas áreas malarígenas criticas.

A double-blind trial of a fixed combination of mefloquine plus sulfadoxine-pyrimethamine compared with sulfadoxine-pyrimethamine alone in symptomatic falciparum malaria

A total of 100 male Zambian patients with symptomatic falciparum malaria were treated with either two tablets of mefloquine plus sulfadoxine-pyrimethamine (Fansimef) or three tablets of sulfadoxine-pyrimethamine (Fansidar) as a single dose. The patients were kept under observation from day 0 (day of treatment) to day 28 and all were cured. An S-type of response was seen in all patients; one patient in the Fansimef group inexplicably remained positive for Plasmodium falciparum trophozoites until day 6. There were no cases of recrudescence.The rate of clearance of parasitaemia was similar in both groups. The rate of clearance of fever was marginally faster in the Fansimef group. Side-effects such as pruritus, diarrhoea and abdominal pain occurred after both drugs but were mild and transient; tolerance was slightly better with Fansimef. Severe orthostatic hypotension occurred in 20% of the Fansidar patients and in only 2% of the Fansimef patients; this was reversed by bed rest. Haematological and biochemical parameters were generally not modified in an undesirable manner by the administration of these drugs.

Pyrimethamine-sulfadoxine still effective against Plasmodium falciparum in Jayapura, Irian Jaya: RI-type resistance in 2 of 18 patients

The sensitivity of Plasmodium falciparum infections to pyrimethamine-sulfadoxine was studied in 18 Indonesian patients in Jayapura, Irian Jaya. In 16 of the 18 patients parasitaemia was cleared by day 6 and the patients remained without parasitaemia through day 28. Two of the 18 patients had late recrudescences consistent with RI-type resistance; one each on days 14 and 21. Pyrimethamine-sulfadoxine is still an effective antimalarial for most patients with falciparum malaria in Jayapura.

A phase II/III double-blind, dose-finding clinical trial of a combination of mefloquine, sulfadoxine, and pyrimethamine (Fansimef) in falciparum malaria

Fansimef is a combination of 250 mg mefloquine (base), 500 mg sulfadoxine, and 25 mg pyrimethamine per tablet. One hundred and fifty adult male Brazilian patients at Belém (Pará), who had peripheral blood smears positive for Plasmodium falciparum, with or without clinical symptoms of falciparum malaria, were treated in a double-blind randomized fashion with either one, two or three tablets of Fansimef. Of those receiving one tablet (48 patients), 81% were cured and 19% exhibited RI recrudescences. All the patients receiving two or three tablets of Fansimef (49 patients in each group) were cured. The rates of initial clearance of parasitaemia and fever were similar in all treatment groups. Tolerance was good at all dose levels. The main side-effects included nausea, vomiting, dizziness, diarrhoea and abdominal pain, but these were mild and transient and required no specific treatment. The incidence of vomiting and nausea was highest in patients given the three-tablet dose. The results of various haematological, biochemical and urine analyses were not adversely altered by the administration of Fansimef.

Mefloquine, sulfadoxine, and pyrimethamine in the treatment of symptomatic falciparum malaria: a double-blind trial for determining the most effective dose

A total of 89 adult male Thai patients who had acute, uncomplicated falciparum malaria were treated in a double-blind randomized trial with a single oral dose of two or three tablets, each consisting of 250 mg mefloquine, 500 mg sulfadoxine, and 25 mg pyrimethamine (MSP). The two-tablet regimen produced a cure rate (S response) of 93%, the three-tablet regimen a cure rate of 98%. The mean duration of parasitaemia for the two- and three-tablet groups was 50 and 29 hours, respectively, while the mean duration of fever was 43 and 40 hours, respectively. Differences between the groups were not statistically significant. Tolerance was good at both dose levels. The main side-effects were abdominal discomfort, nausea, vomiting, dizziness, and diarrhoea, but these were mild, transient, and required no specific treatment. The results of haematological and biochemical investigations and of urinalysis revealed no drug-related changes following administration of MSP. The electrocardiograms of some patients revealed sinus bradycardia or sinus arrythmia, but these conditions were transient, symptomless, and clinically not significant.

Ineffectiveness of clorsulon against Nanophyetus salmincola in coyotes

Efficacy of clorsulon against the trematode Nanophyetus salmincola was evaluated in coyotes. Ten 16-week-old coyote pups were fed fish that contained metacercariae of N. salmincola. Twenty-one days later, 5 of the coyotes were given a suspension of clorsulon (approx 16 mg/kg of body weight, orally). Within 30 days after treatment, the numbers of fluke eggs in fecal specimens from the 5 treated coyotes had not decreased, and numbers of fluke eggs and flukes recovered from treated coyotes at necropsy did not differ from numbers of fluke eggs and flukes recovered from 5 untreated coyotes. Therefore, clorsulon at a dosage of 16 mg/kg was not effective against N. salmincola.

[Pharmacological activity of the furfuryl amine salt of 4-chloro-N-(2-furylmethyl)-5-sulfamoyl anthranilic acid]

Furfuryl amine salt of 4-chloro-N-(2-furylmethyl)-5-sulfamoyl anthranilic acid was shown to exert more pronounced diuretic and saluretic action in rats, mice and dogs than that of furosemide. The previous administration of furfuryl amine salt of furosemide promoted normalization of the excretory processes of the kidney and increased survival rate of rats in ischemia of the single kidney. The antiedema activity of the drug was found to be much more pronounced than that of furosemide.

Chemotherapy and pharmacokinetics of some antimicrobial agents in healthy dwarf goats and those infected with Ehrlichia phagocytophila (tick-borne fever)

The therapeutic efficacy and pharmacokinetics of oxytetracycline (10 mg kg-1), ampicillin (20 mg kg-1) and a combination (TSS) of trimethoprim (20 mg kg-1), sulphadimidine (50 mg kg-1) and sulphamethylphenazole (50 mg kg-1) were investigated in normal dwarf goats and in those infected with Ehrlichia phagocytophila. Goats given oxytetracycline or TSS intravenously showed improvement, whereas ampicillin was ineffective. The infected goats had significantly prolonged elimination half-life values for sulphadimidine and oxytetracycline. The disposition kinetics of ampicillin and sulphamethylphenazole showed no marked differences between the healthy and infected animals. The tick-borne fever model used in the present study can be of value in testing the therapeutic efficacy and pharmacokinetics of chemotherapeutic agents in rickettsial infections.

Concurrent chloroquine- and Fansidar-resistant Plasmodium falciparum: an imported case into Zimbabwe

A case of concurrent chloroquine- and Fransidar-resistant Plasmodium falciparum malaria imported into Zimbabwe by an adult male Zimbabwean from either Malawi or Mozambique is reported. The epidemiological and chemotherapeutic implications are discussed.