A randomized comparison of sulphadoxine-pyrimethamine and combination of sulphadoxine pyrimethamine with chloroquine in the treatment of uncomplicated falciparum malaria in Eastern Sudan.

arly diagnosis and effective treatment with appropriate drug is the main component of the World Health Organization (WHO) strategy to reduce malaria-related mortality.1 For many years the treatment of malaria in Africa has relied on chloroquine, sulphadoxine-pyrimethamine (SP), and quinine, with the latter being used mainly to treat severe cases. Chloroquine and SP are failing and leading to an increase in mortality from malaria especially in East Africa.2 The increasing resistance of Plasmodium falciparum (P. falciparum) in Sudan to chloroquine created urgent needs for evaluation of alternative antimalarial drugs. 3 These should be effective, safe, readily available and affordable. Several African countries have adopted SP as the first line treatment for malaria after chloroquine failure. Sudanese health authority has now adopted SP as the first line treatment for uncomplicated falciparum malaria. High level of resistance to SP across Eastern and Southern parts of Africa has been reported and Eastern Sudan is not an exception.4 Combination of SP with chloroquine could slow down the development of resistance to these drugs. Chloroquine is safe, cheap and has antipyretic effect and it was recently reported to be synergistic to SP in other African countries.5 No data exist in Sudan about combination of SP with chloroquine, hence, this has been the objective of this work. The study was conducted in Elsawagi Alganoubi, Kassala, Eastern Sudan during the period September November 2003. Patients with documented axillary temperature ≥37.5OC and with confirmed uncomplicated P. falciparum infection were included in the study after obtaining informed consent. Patients were excluded if they have concurrent infection, allergy to sulfonamide, or treatment within the last 2 weeks with sulfonamide, quinine, mefloquine or chloroquine. All enrolled patients underwent a thorough history and physical examination by the medical officer and received either SP alone (sulphadoxine 25 mg/kg, Amipharma laboratory, Sudan), or SP as per E Brief Communication