A comparative study of the efficacy of halofantrine and chloroquine in uncomplicated malaria at the Kenyatta National Hospital

Abstract

The aims of this study were to determine and compare the efficacy of chloroquine and halofantrine in uncomplicated malaria; and to compare the outcome of treatment in both groups. A total of 98 patients, 49 per group were recruited into the study. All patients recruited were positive, on blood smear, for P. falciQarum with a mean initial parasiteamia of 1.5 ± 1.49% and 1.45% ± 1.28% for chloroquine and halofantrine respectively. A male to female ratio of 1.45 to 1.0 was coincidentally found for both the chloroquine and halofantrine groups. The mean duration of illness was 4.7 days for the chloroquine group and 4.5 days for the halofantrine group. A mean initial temperature of 37.83 ± 0.98°C and 38.32 ± 0.97°C for chloroquine and halofantrine respectively was observed. 85.7% of the chloroquine treated travelled outside Nairobi province within the past one month. 81.6% of the halofantrine group similarly had travelled outside Nairobi province within the past one month. The mean age in the chloroquine group was 26.4 ± 9.9 years while that in the halofantrine group was 31.7 ± 13.4 years. Clinical features observed at presentation for the chloroquine group were: fever (98%), chills (98%), joint pains (98%), dizziness (89.8%), malaise (89.8%), headache (89.8%), backache (75.5%), nausea (71.4%), vomiting (53.1%), palpitations (53.1%), cough (51.0%) and diarrhoea (46.9%). Clinical features at presentation for the halofantrine group were: chills (98%), fever (91.8%), joint pains (98%), dizziness (91.8%), malaise(89.8%) backache (85.7%), headache (89.8%), nausea (81.6%), vomiting (59.2%), palpitations (53.1%), cough (42.9%) and diarrhoea (34.7%). Parasite clearance time for the chloroquine group was 48.12 ± 26.64 hours as opposed to the significantly shorter parasite clearance time of 37.82 ± 15.91 hours for the halofantrine group (2-tail prob.=0.023). Temperature dissolution time for the chloroquine group was 40.25 ± 24.52 hours as opposed to the shorter temperature dissolution time of 36.52 ± 17.29 hours for the halofantrine group (2 tail) prob.=0.392) . Side effects were uncommon in both groups with pruritus being the most common in each group occurring in 26.5% and 10.2% of the chloroquine and halofantrine groups respectively. Other side effects infrequently noted were headache, cough, diarrhoea, palpitations and rash in a single patient. After a 28 day followup, recrudescence was observeo in 33.3% and 2.94% of the chloroquine and halofantrine~grq~ps respectively. Unfortunately 24.5% and 22.4% of the chloroquine and halofantrine group were lost to follow up. H. P.L.C. estimates of whole blood halofantrine and desbutylhalofantrine revealed a range of 84.2ng/ml - 728.0 ng/ml and 70.0ng/ml - 555.7ng/ml respectively in 12 patients who showed no recrudescence and a halofantrine range of Ong/ml - 10ng/ml and a desbutyl halofantrine range of Ong/ml 14.5ng/ml, in the one patient who had recrudescence in the halofantrine group.