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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682

Rev. Soc. Bras. Med. Trop. vol.21 no.3 Uberaba July/Sept. 1988

http://dx.doi.org/10.1590/S0037-86821988000300005 

ARTICLES

 

Malaria in humait a county, state of Amazonas, Brazil. XIX - evaluation of clindamycin for the treatment of patients with Plasmodium falciparum infection

 

 

Domingos Alves MeiraI; Paulo Camara Marques PereiraI; Jussara Marcondes-MachadoI; Rinaido Poncio MendesI; Benedito BarravieraI; José Antonio G. PirolaI; Maria Regina Cotrim GuimarãesI; Paulo Roberto CuriII; Renato Pedro RodriguesI

IDepartamento de Moléstias Infecciosas e Parasitárias, Dermatologia e Radiologia, Faculdade de Medicina, Campus de Botucatu - UNESP
IIDepartamento de Cirurgia, Faculdade de Medicina, Campus de Botucatu - UNESP

Adress to correspondence

 

 


ABSTRACT

A total of 207 patients with malaria caused by Plasmodium falciparum were submitted to 5 different treatment schedules with clindamycin from 1981 to 1984: A - 89 patients were treated intravenously and orally, or intramuscularly and orally with 20 mg/kg/day divided into two daily applications for 5 to 7 days; B-40 patients were treated orally with 20 mg/kg/day divided into two daily doses for 5 to 7 days; C-27 patients were treated with 20 mg/kg/day intravenously or orally divided into two daily applications for 3 days; D-16 patients were treated orally and/or intravenously with a single daily dose of 20 to 40 mg/kg/day for 5 to 7 days; E-35 patients were treated orally with 5 mg/kg/day divided into two doses for 5 days. Patients were examined daily during treatment and reexamined on the 7th, 24th, 21st, 28th and 35th day both clinically and parasitologically (blood test). Eighty three (40.1%) had moderate or severe malaria, and 97 (46.8%) had shown resistance to chloroquine or to the combination ofsulfadoxin and pyrimethamine. The proportion of cured patients was higher than 95% among patients submitted to schedules A and B. Side effects were only occasional and of low intensity. Three deaths occurred (1.4%), two of them involving patients whose signs and symptoms were already very severe when treatment was started. Thus, clindamycin proved to be very useful in the treatment of patients with malaria caused by Plasmodium falciparum and we recommend schedule A for moderate and severe cases and Bfor initial cases.

Keywords: treatment. Plasmodium falciparum. Clindamycin.


RESUMO

De 1981 a 1984, 207 doentes com malária, causada pelo Plasmodium falciparum, foram tratados com 5 esquemas de clindamicina: A - 89 doente tratados com 20 mg/kg/dia, pelas vias endovenosa e oral, ou intramuscular e oral, em duas aplicações diárias, durante 5 a 7 dias; B - 40 doentes tratados com 20 mg/kg/dia, por via oral, em duas tomadas diárias, durante 5 a 7 dias; C - 27 doentes tratados com 20 mg/kg/dia, por via oral ou endovenosa, em duas tomadas diárias, durante 3 dias; D - 16 doentes tratados com 20 a 40 mg/kg/dia, por vias oral, e/ou, endovenosa, em uma única dose diária, durante 5 a 7 dias; E - 35 doentes tratados com 5 mg/kg/dia, por via oral, em duas doses diárias, durante 5 dias. Os doentes foram examinados, diariamente, durante o tratamento e reexaminados no 7.°, 14.°, 28.° e 35.° dias, tanto pelo exame clínico, quanto pelo parasitológico de sangue. Oitenta e três (40,1%) tinham malária moderada ou grave e 97 (46,8%) tinham apresentado resistência à cloroquina, ou à associação sulfadoxina e pirimetamina. Os resultados mostraram que a proporção de curados foi superior a 95% nos doentes tratados pelos esquemas A e B. Os efeitos colaterais observados foram ocasionais e de pequena intensidade. Houve três casos de óbito (1,4%), dois dos quais atendidos desde o inicio com quadro muito grave. A clindamicina: portanto, mostrou ser muito útil no tratamento de doentes com malária causada pelo Plasmodium falciparum, recomenda-se o esquema A para os casos moderados e o B para os benignos.

Palavras-chave: Tratamento da malária. Plasmodium falciparum. Clindamicina.


 

 

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

 

 

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Adress to correspondence:
Domingos Alves Meira
Departamento de Moléstias Infecciosas e Parasitárias
Dermatologia e Radiologia
Faculdade de Medicina de Botucatu - UNESP
Caixa Postal 522
18610
Botucatu - São Paulo - Brasil.

 

 

Recebido para publicação em 14/12/87.

 

 

Department of Medicine, Federal University of Bahia Medical School, Salvador BA Brazil.
This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq, Brazil (Grant n° 407670/85CL).

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