MALARIA: Paracetamol versus placebo in treatment of non-severe malaria

Poul-Erik Kofoed , Johan Ursing , Amabelia Rodrigues and Lars Rombo
Malaria Journal 2011, 10:148
Paracetamol versus placebo in treatment of non-severe malaria in children in Guinea-Bissau: a randomized controlled trial


Background
The current guidelines for treatment of malaria include paracetamol to children with fever. No convincing evidence for the beneficial effects of this practice exists. Studies show that time to parasite clearance is significantly longer in children treated with paracetamol, which questions the policy. Whether this is of clinical importance has not been investigated.

Methods
Children with Plasmodium falciparum monoinfection and [greater than or equal to]20 parasites per 200 leucocytes at the Bandim Health Centre, Guinea-Bissau were randomized to receive paracetamol or placebo together with chloroquine for three days in a double blind randomized study. Temperature and symptoms were recorded twice daily during treatment and on day 3. The participants were interviewed and a malaria film taken once weekly until day 35. The data is in the form of grouped failure-times, the outcome of interest being time until parasitaemia during follow-up. Mantel-Haenszel weighted odds ratios are given. Other differences between and within the two groups have been tested using the Chi-square test and Mann-Whitney U test.

Results
In the evening of the day of inclusion, the temperature was slightly, but statistically insignificant, higher in the placebo group and significantly more children complained of headache. At no other time was a significant difference in temperature or symptoms detected. However, 6 children from the placebo-group as compared to two children from the paracetamol-group were admitted to hospital with high fever and convulsions by day 3. No differences in the cumulative percentages of children with adequate clinical and parasitological response were found in the intention-to-treat analysis or in the per-protocol analysis.

Conclusion
Fewer children had early treatment failure and the mean temperature was slightly lower in the afternoon on day 0 in the paracetamol group. However, the cumulative adequate clinical and parasitological cure rates were not significantly different during the period of study. It is doubtful whether adding paracetamol to the treatment of uncomplicated malaria in children is benefic

http://www.malariajournal.com/content/10/1/148

Uganda, shortage drugs

Sarah Byasi shakes her head as she runs her finger down the stock page. She is in charge of drug supplies at the Kibogo hospital in Uganda and points to blanks showing there were no modern malaria drugs for adults for the three months until January; and none for children are currently available.
“We give paracetamol if there are no ACTs [artemisinin combination therapy – the current preferred treatment for malaria],” she says – a solution that provides only palliative support to patients suffering the disease’s symptoms of fevers and aches.
Others in local clinics turn to quinine – a “salvage” drug. But its misuse, like that of ACTs, increases the risks of drug resistance that will render treatments still less effective.
Such “stock-outs” highlight how the development of even potent drugs such as ACTs are only the first step to ensure that treatments reach patients. Funding and medical supplies are increasing, yet they are still not saving as many lives as they should.
The frustration is compounded by scenes such as that across the road from Kibogo hospital, where a private pharmacy has no such supply problems. It offers wealthier patients a large range of ACTs – as well as many unauthorised malaria therapies that are ineffective or risk triggering resistance....
http://www.ft.com/cms/s/0/8a9e6f26-4ce6-11df-9977-00144feab49a,dwp_uuid=8d6b86d2-4cd5-11df-9977-00144feab49a.html