A comparative evaluation of sulfalene-trimethoprim and sulphormethoxine-pyrimethamine against falciparum malaria in thailand

TLDR: The efficacies of combinations of sulfalene.trimethoprim (SF-T) and sulphormethoxine-pyrimethamine (S-P) against falciparum malaria in Thailand were assessed and no significant toxic side reactions were observed in subjects administered either one of the combination treatments.

Abstract: The efficacies of combinations of sulfalene.trimethoprim (SF-T) and sulphormethoxine-pyrimethamine (S-P) against falciparum malaria in Thailand were assessed. ThirtY'one patients were given a single dose of SF-T (1 g SF and 0.5 g T) and 34 patients were given Sop (1 g Sand 0.05 g P). Radical cures were observed in 84% of the patients given SF-T and in 91 % of those given S-P Clearances of fever and asexual parasitemias were similar. Factors of previous malaria infections as indicated by both the patients' medical history and by the presence of malaria fluore3cent antibodies and prior antimalarial ihtake showed no apparent influence on treatment outcome. No significant toxic side reactions were observed in subjects administered either one of the combination treatments. A plan for the field use of the long-acting sulfonamide combinations is proposed. Chloroquine-resistant falciparum malaria was ii:::,t reported from Thailand in 1962.' Since that time. investigations performed in Thailand by D:--. Tranakchit Harinasuta,2 SEATO 1vledical Resea:ch LaboratorylS and Thailand Malaria Operationai Research Unit" have shown rates ranging iron 50% to 100%. Because of this problem of chloroquine resis~ (znce and in view of the fact that administration 01 quinine to large numbers of patients in the field is operationally impractical, the need in TnaiIand for a simple and effective regimen against falcipal.:"um malaria is most urgent. Presently, two sulfonamide combinations have the potentlal for meeting this need. These are: 1) sulfalene-trimethoprim (SF-T), and 2) sulphor. Accepted 28 September 1972 ... This study was supported by the Agency f01 International Development, U. S. Department of State, and the U. S Almy, Department of Defense. This is contribution No. 1047 from the Army Malaria Research Progum. t Formerly Chief, TMORU. Plcsent address' American Embassy (Central America .Malatia. Research Station), APO New YOlk 09889. ~Forrncrly EpidemIOlogist, TMORU. § U. S. Army Medical Component, SEATO II Trad Pro{rincial Hospital, Thailand. methoxine (Fanasil,1il Roche)-pyrimethamine (S·P). The purpose of this study ''las to assess these two combinations agains t falciparum malaria in adult Thai males, with respect to rapidity of action, cure rate, the effect of pree."'{isting malaria antibodies on cure rate, and possible side effects, especially side effects in individuals whose erythrOlytes are deficient in glucose-6-ph05phate dehy· drogenase (G-6-PD) activity. MATERIALS ANn :urETHODS The site selected for study was Trad Province, located in Southeast Thailand approximately 400 km from Bangkok (see Fig. 1). Previous investigations have shown that the majority of Plasmodimn jalciparum, strains from this area are chloroquine resistant In 1968, investigations of the chloroquine sensitivity of P jaidparum were conducted in an area 50 km north of Trad Hospital.' Treatment failures following administration of chloroquine were obsen'cd in 8 (80%) of 10 subjects who receIved a total dosage of 25 mg (base)/kg and in 19 (100%) of 19 additional subjects who received a single. dose at 10 mg (base)/kg. Just prior to the present study, Colwell and co-workers reported, from the same hospital, a chloroquine-resistance rate of 93% in