Comparison of quinine-doxycycline and quinine-clindamycin for falciparum malaria in children

  • Ditho Athos P. Daulay Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
  • Yunnie Trisnawati Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
  • Syamsidah Lubis Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
  • Munar Lubis Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
  • Syahril Pasaribu Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
DOI: https://doi.org/10.14238/pi51.4.2011.187-91
Keywords: quinine-doxycycline, quinine-clindamycin, falciparum malaria, parasitemia

Abstract

Objective To compare the efficacy of quinine-doxycycline to quinine-clindamycin combination, as treatment for uncomplicated falciparum malaria in children.

Methods This randomized open labelled controlled trial was conducted from July to August 2007 at Mandailing Natal, Sumatera Utara Province. The subjects were 8 – 18 year old children with positive Plasmodium falciparum from the peripheral blood smear. Simple randomization was performed to determine subject study into two groups of treatment, one group received quinine-clindamycin and the other received quinine-doxycycline treatment. The parasitemia was counted on day 0, 2, 7 and 28. We also observed the adverse effects of the antimalarial combination.

Results Two hundred and forty six children who fulfilled the inclusion criteria were divided into two groups. All subjects completed the study. Cure rate achieved 100% from peripheral blood smear examination at the second day observation and showed no recrudescence at day 28th. (P=0.0001). During 28 days follow up, there were 21 (17.6%) patients suffered from headache, 18 (14.6%) vomit and 40 children (32.5%) suffered from tinnitus in quinine-doxycycline combination, compared to quinine-clindamycin combination group only 4 (3.3%) suffered from headache, 1 (0.8%) suffered from tinnitus and there was no vomiting experience in any patient (P < 0.0001).

Conclusion Combination of quinine with either clindamycin or doxycycline are effective as an alternative antimalarial treatment. The combination of quinine-clindamycin is well tolerated than the combination of quinine-doxyciline, and this combination may be particular value for young children and pregnant women, as these two groups cannot receive doxycycline.

References

1. Soedarmo SS, Garna H, Hadinegoro SR, Satari HI. Malaria. In : Buku ajar infeksi & pediatrik tropis. 2nd ed. Jakarta: IDAI; 2008.p.408-37.
2. Krause PJ. Malaria (Plasmodium). In: Behrman ER, Kliegman MR, Jonson BH, editors. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2004.p.1139-43.
3. Weinberg A, Levin JM. Infections: parasitic & myotic. In: Hay WW, Hayward RA, Levin MJ, Sondheimer JM, editors. Current pediatric diagnosis and treatment. 16th ed. Boston: Mc Graw hill; 2003.p.1213-23.
4. Gupta P. Common protozoal and helminthic infections. In: Gupta P, Paul KV, editors. Essential pediatrics. 5th ed. New Delhi: Mehta; 2001.p.213-18.
5. Whitty CJ, Rowland M, Sanderson F, Mutabingwa TK. Science, medicine, and future: Malaria. BMJ. 2002; 325:1221-4.
6. Azlin E, Batubara I, Dalimunthe W, Siregar C, Lubis B, Lubis M, et al. The effectiveness of chloroquine compared to fansidar in treating falciparum malaria. Paediatrica Indones. 2004;44:17-20.
7. Miller RS, Wongsrichanalai C, Buathong N, McDaniel P, Walsh DS, Knirsh, et al. Effective treatment of uncomplicated plasmodium falciparum malaria with azithromycin-quinine combinations: A randomized, dose-ranging study. Am J Trop Med Hyg. 2006;74:401-6.
8. Ohrt C, Willingmyre GD, Lee P, Knirsch C, Milhous W. Assessment of azithromycin in combination with other antimalarial drugs against plasmodium falciparum in vitro. Antimicrob agents chemother. 2002;46:2518-24.
9. Kremsner PG, Wildling E, Jenne L, Graninger W, Biennzle U. Comparison of micronized halofantrine with chloroquine-antibiotic combinations for treating Plasmodium falciparum malaria in adults from Gabon. Am J Trop Med Hyg. 1994; 50:790-5.
10. Stauffer W, Fischer RP. Diagnosis and treatment of malaria in children. Clin Infec Dis. 2003;37:1340-48.
11. WHO Library Cataloguing-in-Publication Data. Guidelines for the treatment of malaria. Geneva: WHO;2006:108-15.
12. Metzger W, Mordmuller B, Graninger W, Bienzle U, Kremsner PG. High efficacy of short-term quinine-antibiotic combinations for treating adult malaria patients in an area in which malaria is hyperendemic. Am Soc Microbiol, 1995;39:245-46.
13. Pukrittayakamee S, Wanwimolruk S, Stepniewska K, Jantra A, Huyakorn S, Looareesuwan S, et al. Quinine pharmacokinetic-pharmacodynamic relationships in uncomplicated falciparum malaria. Antimicrob Agents Chemother. 2003;47:3458-63.
14. Williams DN, Hermans PE. Tetracyclines and lincosamide. In: Peterson PK, Verhoef J, editors. The Antimicrobial Agents Annual/1. Amsterdam: Elsevier; 1986.p.103-88.
15. Kremsner PG, Graninger W. Clindamycin in the treatment of experimental and human malaria. Rev. Contemp. Pharmacother. 2003;3:275-279.
16. Chambers HF. Chloramphenicol, tetracycline, macrolides, clindamycin and streptomycins. In: Katzung BG, editor. Basic and clinical pharmacology. 7th ed. New York: Mc Graw Hill; 1998.p.743-850.
17. Lell B, Kremsner PG. Clindamycin as an antimalarial drug: review of clinical trials. Antimicrob Agents Chemother. 2002; 46:2315-20.
18. Kremsner PG, Radloff P, Metzger W, Wildling E, Mordmuller B, Philipps J et al. Quinine plus clindamycin improves chemotherapy of severe malaria in children. Antimicrob Agents Chemother. 1995;39:1603-05.
19. Buck ML. Doxycycline for pediatric infection. Pediatric Pharmacotherapy. 2003;9:1-4.
20. Newton NP, Chaulet FJ, Brockman A, Wirongrong C, Dondrop A, Ruangveerayuth R et al. Pharmakokinetics of oral doxycycline during combination treatment of severe falciparum malaria. Antimicrob Agents Chemother. 2005; 49:1622-25.
21. Lallo DG, Shingadia D, Pasvol G, Chiodini PL, Whitty CJ, Beeching NJ et al. UK malaria treatment guidelines. J Inf. 2007;54:111-21.
Published
2011-08-30
How to Cite
1.
Daulay D, Trisnawati Y, Lubis S, Lubis M, Pasaribu S. Comparison of quinine-doxycycline and quinine-clindamycin for falciparum malaria in children. PI [Internet]. 30Aug.2011 [cited 23Dec.2024];51(4):187-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/868
Issue
Vol 51 No 4 (2011): July 2011
Section
Articles

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Received 2016-10-11
Accepted 2016-10-11
Published 2011-08-30