Malaria in Humaita County, State of Amazonas, Brazil. XIX--Evaluation of clindamycin for the treatment of patients with Plasmodium falciparum infection.

A total o f 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 4 0 patients were treated orally with 20 mg/kg/day divided into two daily doses for 5 to 7 days; C 27 pa­ tients were treated with 20 mg/kg/day intravenously or orally divided into two daily applications for 3 days; D -1 6 patients were treated orally and/or intravenously with a single daily dose o f20 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 o f cured patients was higher than 95% among pa­ tients submitted to schedules AandB. Side effects were only occasional and o f low inten­ sity. Three deaths occurred (1.4%), two o f 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 o f patients with malaria caused by Plasmodium falciparum and we recommend schedule A for moderate and severe cases and Bfor initial cases.