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Halofantrine Treatment of Plasmodium falciparum Malaria
- Jeanette K. Doorduijn, MD;
- Pieter J. Wismans, MD; and
- Peter C. Stuiver, MD
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TO THE EDITOR:
We studied the efficacy, safety, and tolerance of halofantrine—a new antimalarial drug for the treatment of chloroquine-and multidrug-resistant Plasmodium falciparum infection [1]. From July 1989 to December 1991, 217 patients were diagnosed with malaria. Plasmodium falciparum was found in 148 (68%). Fifty-one nonimmune patients with uncomplicated infection were eligible to enter the study (34 men and 17 women; mean age, 38.5 years; range, 20 to 70 years). Most noneligible patients had been treated with antimalarial drugs within 14 days or were semi-immune.
Forty-seven patients contracted the infection during their visit to tropical Africa, 31 in West Africa. Forty-three patients had received malaria chemoprophylaxis, most with chloroquine or proguanil. Initial parasite density ranged from 400 to 261 000/µL (geometric mean, 7321/µL).
All patients were hospitalized and treated with halofantrine, 1500 mg, in three divided doses at 6-hour intervals on days 1 and 8. Thick smears were obtained twice daily until negative results were recorded for 24 hours, and on days 7, 14, 21, and 28. After the first course of halofantrine, 50 patients had negative parasite counts on day 7. The parasite clearance time was 74.9 ±29.5 hours. The fever clearance time was 76.9 ±33.6 hours. One patient who had visited Brazzaville, Congo, failed to respond to treatment [2, 3]. He was subsequently cured using mefloquine.
Tolerance of the drug was excellent. Patients reported diarrhea (17%) and dizziness (17%) after the first course, but these symptoms occurred less frequently after the second course (4% and 2%, respectively). We concluded that most symptoms were disease-rather than drug-related.
Hematologic and biochemical measures showed a transient rise of transaminases in 15 patients (29%). The maximum value, found on day 7 in most patients, was 2 to 5 times the normal range (alanine aminotransferase greater than aspartate aminotransferase). Transaminases returned to normal in all patients after therapy was discontinued.
We conclude that halofantrine is effective and well tolerated in the treatment of chloroquine-resistant P. falciparum malaria [4].
Jeanette K.Doorduijn, MD
Pieter J. Wismans, MD
Peter C. Stuiver, MD
Havenziekenhuis; Postbus 70031 3000LN; Rotterdam; The Netherlands
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
