- Email: [email protected]
Quinine and chloroquine antagonism in falciparum malaria
CORRESPONDENCE
425
degree of parasitaemia in various kinds of experiments, the hour at which the blood is collected has to be taken into consideration. It also suggests that the vector might be a haematophagous arthropod which feeds mainly in the afternoon or at sunset. A detailed account of the trials will be published shortly. We are, etc., LEONIDAS M. DEANE J. EVANGELISTADA SILVA LUIZ LOURES FILHO Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Caixa postal 2486, 30 March, 1973 Belo Horizonte, Brazil.
QUININE AND CHLOROQUINEANTAGONISMIN FALCIPARUMMALARIA SIR,--Quinine and chloroquine appear to be antagonistic when given together for falciparnm malaria in Southeast Asia. Radical cure rates for (a) quinine with chloroquine are 5% (HuNsICKER), 35% (REED)and 19% (SHEEHY); for quinine alone 10% (HuNSICKER), 50% (REED) and 29% (SHEEHY). T h e reason for the antagonism is not known. Additional examples of the failure of the combination can be deduced from the paper by BROOKES et al. (1968). REED et al. (1968) observed that "the decline in success rate, when chloroquine is added to quinine appears to be dose related". I n that study they noted that chloroquine not only lacked therapeutic value but also lowered the efficacy of quinine when the 2 drugs were given together. None of the studies quoted is definitive, but the conclusion would appear to be valid unless future studies show otherwise. Meanwhile it seems wise not to give quinine and chloroquine together for the treatment of malaria. I am, etc., A. P. HALL, U.S. A r m y Medical Component, S.E.A.T.O. Medical Research Laboratories, Rajavithi Road, Bangkok, 27 April, 1973 Thailand. REFERENCES BROOKS, M. H., KIEL, F. W., SHEENY, T. W. & BARRY, K. G. (1968). New Eng. J. Med., 279, 732. HUNSlCKER, L. G. (1969). Archs intern. Med., 123, 645. REED, W. P., FEINSTEIN, M. & STEIGER, B. W. (1968). J. Am. reed. Ass., 205, 131. SHEEHY, T. W. & REBA, R. C. (1967). Ann. intern. Med., 66, 616. - - , - & PARKS, G. R. (1969). South reed. J., 62, 152.
TETRAMISOLE IN THE TREATMENT OF ANCYLOSTOMA DUODENALE AND ASCAR1S LUMBRICOIDES INFECTIONS IN EGYPTIANFARMERS S I R , I F o r the past decade bephenium hydroxynaphthoate has been used for the treatment of hookworm infection in Egypt (FARID and MIALE, 1962; ABDALLAHand SAIF, 1963). Piperazine remains the treatment of choice against roundworms in this country (FARID et al., 1966). A single dose treatment, effective simultaneously against both A. duodenale and Ascaris lumbrcoides, has obvious advantages; and although tetramisole has recently been reported to be effective against both these nematode infections (SEFTELand HEINZ, 1968; AL°SAFFAR et al., 1971; VAKIL et al., 1972), no studies on its use have been reported from Egypt. We have found tetramisole to be extremely effective against hookworm and roundworm infections in Egyptian farmers. T h e drug has no side-effects and can safely be given to patients with severe anaemia. A total of 37 male farmers aged 10 to 45 years (mean 23) were treated. 22 of the 37 patients had haemoglobin levels 8 g. O/.oor less (mean haemoglobin for the hookworm-infected patients was 8.5 g. %). 23 were infected with A. duodenale,
425
degree of parasitaemia in various kinds of experiments, the hour at which the blood is collected has to be taken into consideration. It also suggests that the vector might be a haematophagous arthropod which feeds mainly in the afternoon or at sunset. A detailed account of the trials will be published shortly. We are, etc., LEONIDAS M. DEANE J. EVANGELISTADA SILVA LUIZ LOURES FILHO Department of Parasitology, Institute of Biological Sciences, Federal University of Minas Gerais, Caixa postal 2486, 30 March, 1973 Belo Horizonte, Brazil.
QUININE AND CHLOROQUINEANTAGONISMIN FALCIPARUMMALARIA SIR,--Quinine and chloroquine appear to be antagonistic when given together for falciparnm malaria in Southeast Asia. Radical cure rates for (a) quinine with chloroquine are 5% (HuNsICKER), 35% (REED)and 19% (SHEEHY); for quinine alone 10% (HuNSICKER), 50% (REED) and 29% (SHEEHY). T h e reason for the antagonism is not known. Additional examples of the failure of the combination can be deduced from the paper by BROOKES et al. (1968). REED et al. (1968) observed that "the decline in success rate, when chloroquine is added to quinine appears to be dose related". I n that study they noted that chloroquine not only lacked therapeutic value but also lowered the efficacy of quinine when the 2 drugs were given together. None of the studies quoted is definitive, but the conclusion would appear to be valid unless future studies show otherwise. Meanwhile it seems wise not to give quinine and chloroquine together for the treatment of malaria. I am, etc., A. P. HALL, U.S. A r m y Medical Component, S.E.A.T.O. Medical Research Laboratories, Rajavithi Road, Bangkok, 27 April, 1973 Thailand. REFERENCES BROOKS, M. H., KIEL, F. W., SHEENY, T. W. & BARRY, K. G. (1968). New Eng. J. Med., 279, 732. HUNSlCKER, L. G. (1969). Archs intern. Med., 123, 645. REED, W. P., FEINSTEIN, M. & STEIGER, B. W. (1968). J. Am. reed. Ass., 205, 131. SHEEHY, T. W. & REBA, R. C. (1967). Ann. intern. Med., 66, 616. - - , - & PARKS, G. R. (1969). South reed. J., 62, 152.
TETRAMISOLE IN THE TREATMENT OF ANCYLOSTOMA DUODENALE AND ASCAR1S LUMBRICOIDES INFECTIONS IN EGYPTIANFARMERS S I R , I F o r the past decade bephenium hydroxynaphthoate has been used for the treatment of hookworm infection in Egypt (FARID and MIALE, 1962; ABDALLAHand SAIF, 1963). Piperazine remains the treatment of choice against roundworms in this country (FARID et al., 1966). A single dose treatment, effective simultaneously against both A. duodenale and Ascaris lumbrcoides, has obvious advantages; and although tetramisole has recently been reported to be effective against both these nematode infections (SEFTELand HEINZ, 1968; AL°SAFFAR et al., 1971; VAKIL et al., 1972), no studies on its use have been reported from Egypt. We have found tetramisole to be extremely effective against hookworm and roundworm infections in Egyptian farmers. T h e drug has no side-effects and can safely be given to patients with severe anaemia. A total of 37 male farmers aged 10 to 45 years (mean 23) were treated. 22 of the 37 patients had haemoglobin levels 8 g. O/.oor less (mean haemoglobin for the hookworm-infected patients was 8.5 g. %). 23 were infected with A. duodenale,