A trial of Fansidar® plus chloroquine or Fansidar® alone for the treatment of uncomplicated malaria in Gambian children

Chloroquine can no longer be recommended as the first-line treatment for uncomplicated malaria in several parts of Africa because of the increasing prevalence of chloroquine resistance. However, chloroquine was a highly effective treatment for malaria not only because of its ability to kill parasites quickly but also because it is an anti-inflammatory drug. Therefore, we have investigated whether Fansidar® (pyrimethamine/sulfadoxine) plus chloroquine is a more effective treatment for uncomplicated malaria than Fansidar® alone. Four hundred and five Gambian children with uncomplicated Plasmodium falciparum malaria were studied in a randomized controlled trial. Significantly more children treated with Fansidar® alone, compared to those treated with Fansidar® plus chloroquine (19/203 vs. 2/202; P < 0.001), returned to the clinic with persistent symptoms during the first 3 d after treatment. Three children who had received Fansidar® alone had fits, but none of the children treated with Fansidar® plus chloroquine did so. At the day 7 follow-up, the parasite failure rate in the Fansidar® alone group was 3/198 (1.5%), whilst in the Fansidar® plus chloroquine group it was 3/201 (1.5%). At the day 28 follow-up, there was still no significant difference between the parasite failure rate in the Fansidar® alone group (15/150; 10.0%) and the Fansidar® plus chloroquine group (7/141; 5.0%) and the mean packed cell volume (PCV) in the 2 groups was similar. Thus, a combination of Fansidar® plus chloroquine was a more effective symptomatic treatment than Fansidar® given alone, but neither the parasite cure rate nor the PCV was enhanced by use of the combination.