Therapeutic efficacy of clindamycin in combination with quinine for treating uncomplicated malaria in a village dispensary in Gabon

A quinine-clindamycin treatment regimen has been demonstrated to be effective against acute uncomplicated Plasmodium falciparum malaria in children enrolled in hospital-based studies in Gabon. The therapeutic efficacy of this regimen has not been evaluated in a field setting however. To address this research gap 301 children attending a primary school in Dienga Gabon were enrolled in a prospective study. During the 13-month study period (February 1995-March 1996) 256 malaria infections were treated and 161 cases were available for evaluation after exclusion of cases with vomiting and/or incomplete treatment. A child was considered cleared if the blood smear was negative at day 7 after the initiation of treatment and remained negative for the next 2 weeks. Thick blood films were positive in 4 children at day 4 and in 2 at day 7. Thus the treatment regimen had an effectiveness of 97.5% by day 4 and 98.7% by day 7. Between days 8-20 4 other children presented with a positive fortnightly thick blood smear but none had malaria symptoms. The treatment was successfully administered by local health workers and there were no adverse drug reactions. Increased parasite resistance to quinine-clindamycin treatment was not observed during the study period despite multiple infections. This 3-day regimen should be considered as an alternative to chloroquine for the treatment of uncomplicated malaria especially in areas with chloroquine-resistant malaria strains.