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Antimicrobial Agents and Chemotherapy, September 2000, p. 2395-2398, Vol. 44, No. 9
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Therapeutic Responses to Quinine and Clindamycin in Multidrug-Resistant Falciparum Malaria

Sasithon Pukrittayakamee,1 Arun Chantra,1 Sirivan Vanijanonta,1 Ralf Clemens,1,2 Sornchai Looareesuwan,1 and Nicholas J. White1,3,*

Department of Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand1; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom3; and SmithKline Beecham, Collegeville, Pennsylvania2

Received 9 March 2000/Returned for modification 12 May 2000/Accepted 12 June 2000

Therapeutic responses to clindamycin in combination with quinine were assessed in adult Thai patients with uncomplicated multidrug-resistant Plasmodium falciparum malaria. In total 204 patients were randomized to receive a 7-day oral treatment regimen of quinine (Q7) either alone (n = 68), in combination with clindamycin (Q7C7; n = 68), or in combination with tetracycline (Q7T7; n = 68). All patients had uncomplicated recoveries with no serious adverse effects. Fever clearance times for both of the two combination regimens (median of 47 h and range of 8 to 120 h for Q7C7 and median of 36 h and range of 8 to 117 h for Q7T7) were significantly shorter than that for the Q7-only regimen (median, 56; range, 4 to 152 h) (P = 0.002). Parasite clearance times (overall mean ± standard deviation, 78 ± 23 h) were not significantly different between the three treatment groups (P = 0.98). The cure rates assessed at 28 days of follow-up were 100% for Q7C7 and 98% for Q7T7, whereas the cure rate was 87% for the Q7-only regimen (P <=  0.04). Clindamycin in combination with quinine is a safe and effective treatment for multidrug-resistant P. falciparum malaria. This combination may be of particular value in children and pregnant women, in whom tetracyclines are contraindicated.

* Corresponding author. Mailing address: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. Phone: 66-2-246-0832. Fax: 66-2-246-7795. E-mail: fnnjw{at}diamond.mahidol.ac.th.

Antimicrobial Agents and Chemotherapy, September 2000, p. 2395-2398, Vol. 44, No. 9
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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