Search

Fifty subjects with acute uncomplicated falciparum malaria were treated orally with a new micronized formulation of halofantrine. The dose given corresponded to one-half the normal dose for the standard formulation. Parasitemia cleared in all subjects within 78 h. There was recrudescence of falciparum malaria in seven subjects after day 14. The mean +/- standard deviation clearance times of parasitemia and fever were 49.0 +/- 14.2 and 24.3 +/- 13.2 h, respectively. Other clinical symptoms related to malaria cleared within the first 3 days. Pruritus occurred in two subjects, back pain occurred in one subject, and diarrhea occurred in one subject; all of these symptoms were mild. Hematological and biochemical indices were not adversely affected by treatment except in five subjects in whom minor and transitory increases in aspartate aminotransferase and alanine aminotransferase were observed. Micronized halofantrine appears to be a safe, well-tolerated, and effective treatment for acute falciparum malaria in semiimmune patients.

Increasing frequency and severity of cerebral malaria have become a major problem in the area of Yaoundé (Cameroon, Central Africa). Based on recent findings in pharmacokinetic parameters in cerebral malaria, a quinine infusion regimen (8 mg of quinine base/kg of body weight over 1 h followed by 8 mg of base/kg over 7 h, then 8 mg/kg over 8 h 3 times daily for 3 days) was randomly allocated to 10 patients; 10 others received a more classical regimen currently used in Cameroon of 8 mg of base/kg over 8 h, 3 times daily for 3 days. In the loading dose group, there was a significant decrease in the duration of coma (48%), and the parasite clearance times were reduced by 33%. This regimen has been safe and effective: it is recommended in Yaoundé.

The good results achieved in the treatment of malaria with a 7 and 5 days one of quinine (orally dose 8 mg/kg/8 h), incited the authors to try a 3 days long treatment at the same dose. They experimented this protocol on hospitalised children. All patients were free of parasites at day 7 with an average residual concentration quinine of 2.7 +/- 0.8 mg/l. Among the 7 patients with malaria at day 14, 4 didn't require another treatment and 2 presented new infestation. 50% of plasmodial isolated strains were chloroquine resistant and 40% amodiaquine resistant. The efficiency of this protocol could be in favour of its larger use.

One thousand and twenty six P. falciparum strains isolated from cases imported in France and field surveys in four regions of Africa and Madagascar were studied in vitro against chloroquine, monodesethylamodiaquine, quinine and mefloquine, 917 in vivo tests were performed during field studies with chloroquine (10 and 25 mg/kg) and amodiaquine (10, 25, 35 mg/kg). In Madagascar, the chemoresistance remained low and stable during the study period, concerning mostly chloroquine (11% in vitro and in vivo) without obvious geographical variation. 25 mg/kg chloroquine or amodiaquine were satisfactory as respectively first and second line therapeutic regimen. In Central Africa, chemoresistance emerged with an epidemic profile and increased dramatically in disseminated urban focus. High level and prevalence of chloroquine resistance and multiresistance were observed few months after the index cases in these foci. In South West Cameroon, amodiaquine remained efficient as curative treatment but only at a dose of 35 mg/kg/5 days. Decrease of in vitro sensitivity and in vivo efficacy of quinine is a matter of concern. Given the heterogeneous and evolutive situation of drug resistance, the need for epidemiological surveillance and monitoring of P. falciparum drug sensitivity in Africa is obvious to adjust therapeutic regimen.

We present two cases of Plasmodium falciparum malaria contracted in Douala despite adequate prophylaxis by Fansidar for one and by chloroquine for the other. Failure of curative treatment by Fansidar for the first case (in vitro chloroquine-resistant strain) and by amodiaquine plus erythromycin for the second. After these therapeutic failures, both patients presented without fever, but with splenomegaly and anaemia. The successful therapeutic was mefloquine.

Among 172 strains collected in Yaoundé 60% are chloroquine-resistant, 37% are amodiaquine-resistant, instead of quinine and mefloquine which are completely efficient. Among 30 strains collected at a rural health center (where self treatment decreases), 27% are chloroquine-resistant. New therapeutic schemes for first and second line treatment in endemic areas must be evaluated.

A death from chloroquinoresistant falciparum malaria contracted by a traveller under chloroquine chemoprophylaxis during a stay in the Cameroon provides the authors with an opportunity to analyze the extension of chloroquinoresistance in Africa. Having appeared there about 10 years ago, it remained for a long time localized in East Africa. In recent years, it has moved West. Today, 17 countries located from the North to the South between Sudan and Mozambique, and from East to West between Kenya and the Cameroon are affected, as are the Malagasy Republic, the Comores and Zanzibar. The strains resistant to chloroquine are still sensitive to amodiaquine. In certain regions which are widespread in the continent, resistance to pyrimethamine has become evident in the last 30 years; resistance to pyrimethamine-sulfadoxine and pyrimethamine-dapsone has appeared in the last 3 years in East Africa. In the light of the complexity of the problem of malaria chemoprophylaxis, the authors emphasize the necessity of resensitizing the public at large with respect to personal protection against biting anopheline mosquitos, especially during the hours of darkness. The medical profession should equally be made aware of these new problems. Three types of chemoprophylaxis in relation to the areas visited are proposed: the first for West Africa; the second for Central Africa, neighbouring regions and the Malagasy Republic and the Comores; the third for the 3 East Africa countries the most affected, which are Kenya, Burundi and Tanzania.