Therapeutic Responses to Quinine and Clindamycin in Multidrug-Resistant Falciparum Malaria

Therapeutic responses to clindamycin in combination with quinine were assessed in adult Thai patients with uncomplicated multidrug-resistant Plasmodium falciparum malaria. In total 204 patients were randomized to receive a 7-day oral treatment regimen of quinine (Q 7 ) either alone ( n = 68), in combination with clindamycin (Q 7 C 7 ; n = 68), or in combination with tetracycline (Q 7 T 7 ; n = 68). All patients had uncomplicated recoveries with no serious adverse effects. Fever clearance times for both of the two combination regimens (median of 47 h and range of 8 to 120 h for Q 7 C 7 and median of 36 h and range of 8 to 117 h for Q 7 T 7 ) were significantly shorter than that for the Q 7 -only regimen (median, 56; range, 4 to 152 h) ( P = 0.002). Parasite clearance times (overall mean ± standard deviation, 78 ± 23 h) were not significantly different between the three treatment groups ( P = 0.98). The cure rates assessed at 28 days of follow-up were 100% for Q 7 C 7 and 98% for Q 7 T 7 , whereas the cure rate was 87% for the Q 7 -only regimen ( P ≤ 0.04). Clindamycin in combination with quinine is a safe and effective treatment for multidrug-resistant P. falciparum malaria. This combination may be of particular value in children and pregnant women, in whom tetracyclines are contraindicated.