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Comparative efficacy of chloroquine and cotrimoxazole in the treatment of acute uncomplicated falciparum malaria in Nigerian children.

OBJECTIVES
To evaluate the efficacy of two dosing regimens of cotrimoxazole in the treatment of falciparum malaria and compare the efficacy with that of chloroquine, the first-line antimalaria drug in the area of study.


DESIGN
A prospective cross sectional study.


SETTINGS
Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.


SUBJECTS
Ninety eight children with acute symptomatic uncomplicated falciparum malaria.


MAIN OUTCOME MEASURES
Fever and other symptoms clearance times, parasite clearance times and the cure rates for chloroquine, three day and five day cotrimoxazole.


RESULTS
Ninety eight children with acute symptomatic uncomplicated falciparum malaria were randomised to receive three doses of oral chloroquine and two regimens of cotrimoxazole. Pre-treatment clinical and parasitological parameters were similar in the three treatment groups. The fever and other symptoms clearance times were comparable in all the treatment groups: 1.83 +/- 1.3, 1.9 +/- 1.0 and 2.4 +/- 1.3 days for chloroquine, three day cotrimoxazole and five day cotrimoxazole, respectively p = 0.24. Parasite clearance times for the three treatment groups were also similar; 3.0 +/- 1.0, 3.1 +/- 0.7, and 3.0 +/- 1.0 days respectively for chloroquine, three day- and five day- cotrimoxazole; p = 0.96. The cure rates for chloroquine, three day and five day cotrimoxazole were 74.2%, 88.2% and 84.8%, respectively (x2 = 2.40, p = 0.30). The three treatment regimens were well tolerated.


CONCLUSION
These results indicate that cotrimoxazole is as effective as chloroquine in treatment of acute symptomatic uncomplicated falciparum malaria in children resident in an endemic area of southwest Nigeria. It is an added advantage when malaria coexists with respiratory tract infections for which cotrimoxazole is the recommended drug.