Biomedical subjects

A Sowunmi

Publications and source records attributed to A Sowunmi.

At least 55 records · Page 3Linked to original sources

PubMed2000

The pharmacokinetics of caffeine in Nigerian children suffering from malaria and kwashiorkor.

OBJECTIVES: Caffeine-containing beverages are generally consumed by Nigerians suffering from malaria and kwashiorkor in the belief that caffeine aids early recovery from these illnesses, which are common in the tropics. However, there are no studies on the influence of these diseases on the absorption and pharmacokinetics of caffeine in Africans. MATERIALS AND METHODS: A single oral dose of caffeine was given to five healthy children and to five and seven children suffering from malaria and kwashiorkor, respectively. Caffeine and its dimethylxanthine metabolites were measured in plasma using high-performance liquid chromatography. RESULTS: The maximum plasma concentration (Cmax) of caffeine and the time of Cmax were similar (P > 0.05) in the three groups. However, the elimination half-life of caffeine was significantly longer in children with malaria (9.2 +/- 3.5 h) (P < 0.01) and kwashiorkor (13.1 +/- 7.9 h) (P < 0.05) than in the healthy controls (3.7 +/- 1.8 h). The total plasma oral clearance of caffeine of 4.4 +/- 1.9 ml/min/kg in healthy children was significantly higher (P < 0.01) than in those with kwashiorkor (2.0 +/- 0.9 ml/min/kg) and malaria (1.6 +/- 1.0 ml/min/ kg) (P < 0.05). Paraxanthine was the principal metabolite in all the three groups with Cmax significantly higher in healthy children (1.3 +/- 0.3 microg/ml) than in children with malaria (0.8 +/- 0.4 microg/ml) (P < 0.05) and kwashiorkor (0.3 +/- 0.1 microg/ml) (P < 0.0001). CYP1A2 activity, measured by the plasma ratios of paraxanthine: caffeine, was significantly lower in kwashiorkor and malaria. CONCLUSIONS: This study showed that the plasma kinetics of caffeine are significantly altered in malaria and kwashiorkor, and CYP1A2 activity was lower in these two disease groups.

Administration, Oral↗

PubMed2000

The effects of acute falciparum malaria on the disposition of caffeine and the comparison of saliva and plasma-derived pharmacokinetic parameters in adult Nigerians.

OBJECTIVES: The pharmacokinetics of caffeine and its dimethylxanthine metabolites were evaluated in Nigerians, for whom it is normal to consume caffeine-containing beverages during ill health and recuperation in the belief that caffeine aids early recovery from illness; however, there are no data defining the kinetics of caffeine in healthy and ill Nigerians. MATERIALS AND METHODS: A single oral dose of 300 mg caffeine was given to ten healthy adult Nigerians and ten adults suffering from acute uncomplicated Plasmodium falciparum malaria infection. Caffeine and its dimethylxanthine metabolites were measured in plasma and saliva of healthy subjects and in plasma of patients suffering from malaria using high-performance liquid chromatography. RESULTS: The plasma pharmacokinetics of caffeine per se in both groups was similar (P > 0.05). The maximum plasma concentration (Cmax) of paraxanthine was significantly lower (P < 0.05) in malaria (0.9 +/- 0.4 microg/ ml) than in healthy controls (1.4 +/- 0.5 microg/ml), and the paraxanthine:caffeine area under the plasma concentration time curve ratio, an index of cytochrome P450 (CYP)IA2 activity was significantly lower (P < 0.05) in malaria patients (0.5 +/- 0.1) than in healthy controls (0.3 +/- 0.2). The elimination half-life of theophylline was longer in malaria, while the area under the plasma concentration time curve of theobromine was significantly higher (P < 0.05) in malaria (7.1 +/- 3.4 microg ml(-1) h) than in healthy adults (4.1 +/- 2.2 microg ml(-1) h). Excellent correlations were found between saliva and plasma concentrations of caffeine (r2 = 0.98) with a mean saliva:plasma concentrations ratio of 0.7 +/- 0.1. The plasma concentrations (Cmax and AUC) were therefore higher than the corresponding salivary levels, so that the apparent oral clearance calculated for saliva exceeded the true oral clearance based on plasma data. CONCLUSIONS: Acute Plasmodium falciparum malaria produced significant changes in the disposition of caffeine metabolites. Analysis of concentrations in saliva is a useful non-invasive method for monitoring the kinetics of caffeine and paraxanthine in Nigerians.

Acute Disease↗

PubMed2000

Comparative efficacy of chloroquine plus chlorpheniramine alone and in a sequential combination with sulfadoxine-pyrimethamine, for the treatment of acute, uncomplicated, falciparum malaria in children.

One hundred and eight children with acute, symptomatic, uncomplicated, falciparum malaria were randomized to receive chloroquine (for 3 days) plus chlorpheniramine alone (for seven days) (CQ-CP group; N = 55) or, in a sequential treatment, chloroquine plus chlorpheniramine for 3 days followed, on the fourth day, by a single oral dose of sulfadoxine-pyrimethamine (25 mg sulfadoxine/kg) (CQ-CP-SP group; N = 53). The mean (S.D.) parasite-clearance time in the CQ-CP group [2.1 (0.7) days; range = 1-5 days] was similar to that in the CQ-CP-SP [2.1 (0.8) days; range = 1-5 days]. The fever-clearance times were also similar: 1.2 (0.1) days (range = 1-3 days) v. 1.1 (0.4) days (range = 1-3 days). The cure rates on days 14, 21 and 28 were 98.2%, 96.3% and 92.7%, respectively in the CQ-CP group, and 100%, 100% and 96.2%, respectively, in the CQ-CP-SP group. The rates of gametocyte carriage were low and similar (5.4% in the CQ-CP group and 3.8% in the CQ-CP-SP group) throughout the duration of the study. Both treatment regimens were relatively well tolerated, the main adverse reactions being similar: sleepiness (on day 1) and pruritus (on days 1-3). No adverse effect was attributable to SP. The results indicate that sequential treatment, for 3 days with CQ and CP, followed by a single dose of SP, is effective and well tolerated in children with acute, uncomplicated, falciparum malaria and may be an alternative treatment for CQ- and/or SP-resistant falciparum malaria. Treatment with a CQ-CP combination (CQ and CP for 3 days and then CP alone for another 4 days) is also effective but requires continuing administration after the signs and symptoms of acute malaria have disappeared.

Animals↗

PubMed2000

Comparative clinical characteristics and response to oral antimalarial therapy of children with and without Plasmodium falciparum hyperparasitaemia in an endemic area.

The clinical characteristics and the responses to oral antimalarial therapy of 104 children presenting consecutively with or without Plasmodium falciparum hyperparasitaemia (HP) were investigated in an endemic area. At presentation, although the 52 children with HP were significantly younger and had significantly higher heart rates than the 52 without, there were no significant differences between the two groups in their symptoms or in any other clinical feature of their malaria. Responses to oral antimalarial drugs were similar in both groups. Analysis of the disposition kinetics of parasitaemia, using a non-compartmental model similar to that used in characterizing drug disposition, showed that the two groups had similar half-lives of parasitaemia (t1/2pd), volumes of blood completely cleared of parasites per unit time (CLBpd), and parasite-clearance-time:t1/2pd ratios. Three children in the HP group, all aged < 3 years, progressed to cerebral malaria within 8 h of presentation, and another HP child presented with isolated trunkal ataxia, indicative of cerebellar involvement. No child in the non-HP group had any of the features of severe malaria. Although the clinical characteristics and responses to oral therapy of children with and without HP are therefore very similar, young children with HP appear to have an increased risk of developing other features of severe malaria.

Adolescent↗

PubMed2000

Arginine vasopressin secretion in Kenyan children with severe malaria.

Hyponatraemia is common in African children with severe malaria, but the cause is unknown. We measured plasma sodium (p[Na]) and arginine vasopressin concentrations (p[AVP]) in 30 consecutive children with severe malaria (19 had cerebral malaria), on admission, at 48 and 96 h after admission. Hyponatraemia (p[Na] < 130 mmol/l) occurred in 53 per cent of the children and was unrelated to peripheral parasite density, dehydration or abnormal renal function. The highest p[AVP] were seen in patients with cerebral malaria. Overall, p[AVP] declined 96 h after treatment. In children with hyponatraemia (cerebral and non-cerebral), p[AVP] levels were not suppressed and in 67 per cent of cases they were deemed inappropriate. Inappropriate AVP secretion is common in children with severe malaria and may influence fluid therapy after correction of initial dehydration.

Arginine Vasopressin↗

PubMed2000

Bioavailability of ciprofloxacin and fleroxacin: results of a preliminary investigation in healthy adult Nigerian male volunteers.

The absolute bioavailability (BA) of ciprofloxacin and fleroxacin were evaluated in 19 adult Nigerian male volunteers. Subjects meeting the selection criteria were randomized to receive treatment either with fleroxacin (200 mg-i.v. and 200 mg oral dose) or ciprofloxacin (200 mg-i.v. and 250 mg oral dose). The i.v./oral or oral/i.v. switch was made after a one week washout period. Blood and urine samples were collected at pre-determined time intervals over a 72 h period for analysis of drug levels. Following intravenous administration the maximum serum concentration (Cmax) was 2.7+/-1.06mg/l for ciprofioxacin and 0.99+/-0.41 mg/l for fleroxacin; the area under the blood level curve (AUC) was 8.82+/-3.19 mg x h/l with ciprofloxacin and 8.52+/-3.83 mg x h/l with fleroxacin. Following oral administration the Cmax was 1.52+/-0.94 mg/l with ciprofloxacin and 0.57+/-0.08 mg/l with fleroxacin; the AUC was 9.87+/-4.10 and 7.55+/-1.42 mg x h/l, respectively. The absolute BA following oral administration was found to be 0.79+/-0.47 for ciprofloxacin and 1.01+/-0.78 for fleroxacin. When these BA results were corrected for renal clearance [Cl(r)] and elimination half-life (t1/2) the values were reduced to 0.37+/-0.17 and 0.31+/-0.18, respectively, for ciprofloxacin and 0.53+/-0.23 and 0.99+/-0.38, respectively, for fleroxacin. Only 38% with ciprofloxacin and 59% with fieroxacin, of the administered dose, was excreted unchanged following oral administration. More work, however, needs to be done on ciprofloxacin to support and/or confirm the above findings. Fleroxacin, on the one hand, exhibited a different trend from that observed in the literature with respect to Cmax and AUC where the values observed in this study were 3--4 fold lower than expected following identical doses, whilst on the other hand the observed BA profile in this study was consistent with literature trends.

Adult↗

PubMed1998

Viability of Plasmodium falciparum ex vivo: comparison of the effects of artemether and sulfadoxine-pyrimethamine.

OBJECTIVE: Severe malaria is increasingly treated with artemether and sulfadoxine-pyrimethamine, but their effects on the viability of Plasmodium falciparum ex vivo following therapeutic doses, and the relationship between conventional indices of therapeutic response and parasite viability, have not been evaluated. We assessed these parameters in children with severe non-cerebral falciparum malaria. METHODS: Between May and August 1995, 17 children with severe non-cerebral malaria were randomized to receive therapeutic doses of artemether or sulfadoxine-pyrimethamine. Parasitemia quantification and withdrawal of blood culture of P. falciparum in vitro were done before and at specific intervals after drug administration. Therapeutic indices of response were determined by the conventional method. The corresponding viability estimates ex vivo were derived for each drug and compared with conventional therapeutic indices. RESULTS: Artemether produced a significantly more rapid reduction of parasitemia and fever than sulfadoxine-pyrimethamine. Resistance to sulfadoxine-pyrimethamine was present in three out of seven patients (RI, RII and RIII) and was readily detectable by the functional viability estimate ex vivo. Ex vivo, functional reduction of parasite viability was significant 8 or 12 h after administration of artemether, with no functionally viable parasites 30 h after administration. In contrast, functional viability in isolates sensitive to sulfadoxine-pyrimethamine became significant by 16-20 h after drug administration and viable parasites were still evident after 36 h in some isolates. Indices of therapeutic response estimated by the conventional methods, i.e., time to 50% or 90% reduction of parasitemia and parasite clearance time, were significantly higher than those derived from the corresponding functional viability estimates ex vivo for each drug. There was correlation between some of the two sets of parameters. CONCLUSIONS: These data suggest the rapid and relatively broad stage effects of artemether when compared with sulfadoxine-pyrimethamine on P. falciparum asexual forms. Estimation of parasite viability indices ex vivo permits comparison of the relative speed of antimalarial drug action.

Adolescent↗

PubMed1998

Pharmacokinetics of quinine in African patients with acute falciparum malaria.

The pharmacokinetics of quinine were studied in six Nigerian patients during acute uncomplicated falciparum malaria and convalescent periods. An oral dose of 10 mg/kg quinine dihydrochloride administered 8-hourly for 7 days gave parasite and fever clearance times of 36.0 +/- 16.6 h and 18.0 +/- 6.4 h, respectively. From the individual quinine plasma profiles the mean plasma concentration of quinine at the time of parasite clearance was estimated as 4.5 +/- 1.1 micrograms/ml. Plasma quinine levels during malaria rose rapidly reaching a peak around the second and third days and declining thereafter as patients improved clinically. In acute malaria plasma quinine levels were more than two-fold higher than in convalescence; the mean AUC(0-12) in malaria was 37.9 +/- 14.7 micrograms.h/ml compared to 17.9 +/- 8.5 micrograms.h/ml in convalescence. The apparent oral clearance (CL/F) and volume of distribution (Vd/F) during the acute phase of the malaria (1.9 +/- 0.7 ml/min/kg and 1.8 +/- 0.9 l/kg, respectively) were significantly lower than in convalescence (4.5 +/- 2.1 ml/min/kg and 4.2 +/- 3.2 l/kg). The present data suggest that malaria parasites in African patients are still very sensitive to quinine and that the current dosage of quinine is effective for the treatment of acute falciparum malaria in African patients without augmenting therapy with any other drug such as tetracycline or sulphadoxine-pyrimethamine. It also confirms that malaria significantly alters the pharmacokinetics of quinine in humans.

Acute Disease↗

PubMed1998

Enhancement of the antimalarial effect of chloroquine by chloropheniramine in vivo.

The efficacy of chloroquine and chloroquine plus chloropheniramine, a histamine H1 receptor blocker which reverses chloroquine insensitivity in Plasmodium falciparum in vitro, was studied in 96 children with acute symptomatic uncomplicated falciparum malaria. The chloroquine/chloropheniramine combination produced a significantly higher cure rate than chloroquine alone and cured 77% of children with chloroquine treatment failures. Children with chloroquine treatment failure had mean plasma chloroquine concentrations above the minimum therapeutic concentration for the area. Chloroquine concentrations in plasma and red blood cells and ratio of red cell to plasma chloroquine concentrations on days 3 and 7 after initiation of therapy were not significantly different in the two groups. Chloroquine/chloropheniramine produces a higher cure rate than chloroquine alone and reverses chloroquine insensitivity in Plasmodium falciparum in vivo. It may be a useful way of optimising the antimalarial effect of chloroquine.

Antimalarials↗

PubMed1998

Efficacy of chloroquine plus chlorpheniramine in chloroquine-resistant falciparum malaria during pregnancy in Nigerian women: a preliminary study.

The efficacy of chloroquine plus chlorpheniramine, a histamine H receptor antagonist, which reverses chloroquine 1 insensitivity in Plasmodium falciparum in vitro and in vivo , was evaluated in 30 pregnant women with recrudescent chloroquine-resistant Plasmodium falciparum malaria. All patients had at least one or more treatment failures with one or more courses of chloroquine or pyrimethamine-sulphadoxine. There was a prompt response to treatment with parasitaemia and fever clearing in all patients within 48 and 96 hours respectively of commencement of therapy with the combination. The cure rate on day 14 was 77%. Parasitaemia recurred in seven patients after day 14 and was successfully treated with oral mefloquine. The combination was well tolerated; pruritus and drowsiness were the only noticeable adverse effects. The progress of pregnancy and its outcome were not adversely affected by treatment with the combination. When fully developed, the combination of chloroquine plus chlorpheniramine may be an alternative in the treatment of chloroquine-resistant malaria during pregnancy in Nigerian women.

Journal Article↗

PubMed1998

Randomised trial of artemether versus artemether and mefloquine for the treatment of chloroquine/sufadoxine-pyrimethamine-resistant falciparum malaria during pregnancy.

The efficacy of artemether and artemether followed by mefloquine was evaluated in 45 pregnant women with drug resistant Plasmodium falciparum malaria during the second and third trimesters. There was prompt clinical response to both treatment regimens. The parasite and fever clearance times and the cure rate were similar in both groups. Except for the correlation between initial parasite density and fever clearance time in the artemether-mefloquine group, there was no correlation between initial parasite density and parasite or fever clearance times in the two groups. Similarly, there was no correlation between parasite and fever clearance. Both treatment regimens were well tolerated. All newborn babies of the participating women were normal at birth. Physical and neurodevelopmental assessment of the newborn babies followed up for a period varying between 6 and 36 months were within normal limits. Artemether alone or with mefloquine are effective and do not produce undue deleterious effects in pregnant patients with drug-resistant falciparum malaria during the second and third trimesters.

Clinical Trial↗

PubMed1998

In vitro and in vivo reversal of chloroquine resistance in Plasmodium falciparum with promethazine.

The effect of combining promethazine with chloroquine was examined against Plasmodium falciparum in vitro in the Aotus-P. falciparum model and in bioassays from volunteers given promethazine. The combination of chloroquine plus promethazine (1 x 10(-6) M) reversed chloroquine resistance in standard P. falciparum clones and patient parasite isolates from Nigeria. The combination reduced the 50% inhibitory concentrations (IC50s) for chloroquine against resistant parasites by 32-92%. Coadministration of promethazine with chloroquine also demonstrated a dose-dependent effect in Aotus monkeys infected with chloroquine-resistant P. falciparum. Monkeys were given a chloroquine dose (20 mg/kg of body weight for seven days), which normally has no effect on parasitemia, plus 10, 20, 40, or 80 mg of promethazine/kg of body weight. In one monkey, parasitemia was suppressed at the lowest promethazine dose, but re-treatment with 20 mg/kg resulted in clearance of parasitemia. Initial treatment with chloroquine and 20 or 40 mg/kg of promethazine cleared parasitemia in some animals followed by recrudescence. Re-treatment at higher doses cured one monkey and resulted in initial clearance and delayed recrudescence 28 or 63 days after treatment in two monkeys. Recrudescent parasitemia in the two monkeys was low (10 parasites/microl of blood) and subsequently cleared without re-treatment. An in vitro bioassay model was developed to examine the effects of clinically achievable doses of promethazine on parasites susceptibilities in vitro. Plasma samples taken at hourly intervals from patients given a single oral dose of 25 mg of promethazine decreased the IC50 values for chloroquine by 20-58% with the most significant reductions occurring in plasma obtained from volunteers 3-4 hr after ingestion. Plasma obtained from two volunteers 6 hr after ingestion of the drug demonstrated no effect on chloroquine susceptibility, suggesting that study of the pharmacokinetic disposition and potential interaction is warranted to optimize the dose regimen in patients for antimalarial efficacy. Historic use of this drug combination for treatment or prevention of chloroquine-associated pruritus or as an antiemetic suggest that the combination is safe and effective when used at standard dosages. The results from this study demonstrate that promethazine is a potent modulator of chloroquine resistance. Clinical evaluation of therapeutic regimens is required to validate clinical efficacy of this promising combination for treatment of uncomplicated chloroquine-resistant malaria.

Adult↗

PubMed1997

Plasmodium falciparum: evaluation of lactate dehydrogenase in monitoring therapeutic responses to standard antimalarial drugs in Nigeria.

The correlation of P. falciparum lactate dehydrogenase (pLDH) activities and patent infections was evaluated for monitoring therapeutic responses and drug resistance in 70 patients with microscopically confirmed P. falciparum malaria in Nigeria. Each patient was treated with standard dosages of artemether (53 patients), chloroquine (7 patients), sulfadoxine-pyrimethamine (6 patients), or halofantrine (4 patients). Response of infection to treatment was monitored by microscopic examination of thick and thin blood smears, clinical symptoms, and levels of pLDH activities in blood products. pLDH activity was determined using an antibody capture technique and 3-acetyl pyridine adenine dinucleotide developed to enhance sensitivity of the enzyme detection. All patients treated with artemether were cured while 5 patients treated with chloroquine, 1 treated with sulfadoxine-pyrimethamine, and 2 treated with halofantrine suffered recrudescent infections after treatment. pLDH activity was detected in blood products obtained from patients with patent or recrudescent infections determined by microscopy and clinical symptoms. Levels of pLDH activities in whole blood and packed cells from the patients correlated with qualitative detection of parasites in blood smears and in patients with high gametocyte counts. Gametocyte counts in the patients after treatment ranged from 40 gametocytes/microliter of blood to 4923 gametocytes/microliter of blood. There is a consistent relationship between patent infection and pLDH activities that could easily be determined in whole blood and packed cells from the patients. Further development of the procedure will enhance its valuable application in clinical management of drug-resistant malaria in the endemic areas.

Adolescent↗

PubMed1997

Artemether treatment of recrudescent Plasmodium falciparum malaria in children.

Intramuscular artemether given for five days was evaluated prospectively in 32 patients with acute recrudescent Plasmodium falciparum malaria. All patients had experienced one or more treatment failures with one or more courses of the following drugs: chloroquine, amodiaquine, sulphadoxine-pyrimethamine and erythromycin given alone or in combination. There was a prompt response to treatment with fever and parasite clearance times of 10.7 (3.6) h (range 6-24) and 32.3 (8.3) h (range 24-48) respectively. Parasite reduction at 24 h was 93.2 (7.8)% (range 75-100). The cure rate on day 14 was 100%. The drug was well tolerated. These results suggest that artemether is rapidly effective in acute recrudescent Plasmodium falciparum malaria and is without deleterious side effects.

Acute Disease↗

PubMed1996

Effect of dose size on the pharmacokinetics of orally administered quinine.

Plasma concentrations of quinine were measured by high-performance liquid chromatography (HPLC) after oral administration of 250, 500 and 1000 mg base to seven healthy adults. The doses were administered after an overnight fast. A washout period of at least 21 days was allowed between the doses. Area under the plasma concentration-time curve (AUC) for quinine increased in approximate proportion to the dose from 250 to 1000 mg. There was also a linear relationship between dose and maximum plasma concentration and dose and AUC in individual subjects. Time to reach peak plasma concentration remained unchanged over the dose range. There was no significant difference in elimination half-life, volume of distribution and systemic clearance over the dose range. The occurrence of adverse effects was dose and plasma quinine concentration dependent; central nervous system side effects increased as dose and plasma concentrations increased. These data suggest that after oral administration of quinine, linear pharmacokinetics occur in the dose range of 250-1000 mg.

Administration, Oral↗

PubMed1996

Efficacy of artemether in severe falciparum malaria in African children.

The clinical efficacy of intramuscular artemether was studied in 144 children suffering from severe non cerebral malaria. Fifty-three children with chloroquine-resistant and 27 children with sulfadoxinepyrimethamine-resistant falciparum malaria were also studied. Greater than 95% of pre-treatment parasitaemia was cleared by 24 h after commencement of treatment in all groups. The parasite and fever clearance times were 35.4 +/- 8.0 and 18.6 +/- 6.3 h respectively, in children suffering from severe non cerebral malaria 36.3 +/- 7.9 and 15.6 +/- 3.8 h, respectively, in the chloroquine-resistant and 36.8 +/- 8.8 and 16.5 +/- 4.2 h, respectively, in the sulfadoxine-pyrimethamine-resistant groups. The cure rate in all groups on day 14 was 100%. Side effects following treatment were minimal and comprised pain with mild tenderness at site of injection in two children and bradycardia, on the second or third day of treatment, in another two patients. No patient had pruritus. These data suggest that artemether is rapidly effective in falciparum malaria in children irrespective of previous drug treatment and especially in chloroquine- or sulphadoxinepyrimethamine-resistant infection and in this study was without deleterious side effects.

Adolescent↗

PubMed1996

Open comparison of artemether and mefloquine in uncomplicated Plasmodium falciparum hyperparasitaemia in children.

The efficacy of intramuscular artemether given for 5 days and a single oral dose of mefloquine, 25 mg/kg/body-weight, was evaluated in 84 children with uncomplicated Plasmodium falciparum hyperparasitaemia ( > 5% parasitized erythrocytes). Follow-up was for 14 days in the artemether group and 28 days in the mefloquine group. Artemether produced a significantly higher parasite reduction at 24 hours [mean 90.6 vs 63.3%, 95% confidence interval 10.7-43.9] and significantly shorter parasite clearance time [mean 38.4 vs 49.3 hours, 95% confidence interval 5.5-16.3] than mefloquine. Fever clearance times were similar, presumably because of the use of an antipyretic in both treatment groups. Cure rate was 98% with artemether on day 14 and 100% with mefloquine on day 28. One child in the artemether group who had recurrence of parasitaemia on day 14 responded promptly to mefloquine with clearance of parasitaemia and fever at 24 hours. Although both drugs were well tolerated, mefloquine produced more episodes of abdominal pain with or without diarrhoea and vomiting. These results suggest that both drugs are effective in uncomplicated Plasmodium falciparum hyperparasitaemia in children from an endemic area of south-west Nigeria.

Administration, Oral↗

PubMed1996

Renal function in acute falciparum malaria.

Renal function was assessed in 40 children during the acute illness and after recovery from falciparum malaria. Creatinine clearance was significantly lower during the acute illness than after recovery. Six of 18 children with impaired creatinine clearance (< 50 ml/min/1.73 m2) had evidence of acute tubular dysfunction. Hyponatraemia occurred in 12.5% during the acute phase. Fractional sodium excretion was raised in 27% during the acute illness and continuing sodium wastage occurred in 17% after recovery. Plasma potassium was significantly higher and fractional potassium excretion (FeK) significantly lower during the acute illness than after recovery. There was a positive correlation between FeNa and FeK both during and after recovery from the illness but they did not exactly mirror each other in every individual. Urine sodium:potassium ratios were similar during and after recovery from the illness and was related to FeNa. Fractional glucose excretion was zero. Mild proteinuria occurred in 40% during the acute illness but were not related to creatinine clearance, body temperature at presentation, or peripheral parasite density. Proteinuria was absent after recovery. Acute intrinsic renal impairment occurs during apparently 'uncomplicated' falciparum malaria in children.

Acute Disease↗