Clinical Efficacy of Selected Antimalarials with and Without Concomitant Administration of Antibacterials

Abstract

Background: There is a high rate of malaria treatment failure even with the use of the artemisinin combination therapy (ACT). Studies have revealed that some bacteria infections present the same symptoms as uncomplicated and severe malaria. In most outpatient clinics, prescriptions are based only on the symptoms presented by the patients.

Objectives: To determine the prevalence of concomitant bacterial infection in malaria parasitaemia, evaluate the type of bacteria and assess the effect of the concomitant administration of five classes of antibacterial and antimalarials on the symptoms presented by the patients.

Methodology: Malaria parasitaemia was determined by thick and thin blood smears stained with Giemsa. Blood samples were cultured in MacConkey, chocolate and blood agar respectively using oxoid signal system after the manufacturers’ instructions and microbial load was determined by pour plate method.

Results: Out of the 210 symptomatic cases 170 (80.95%) were found infected with malaria out of which 96 (56.47%) had bacterial co-infection and 74(45.53%) had malaria mono-infection. Of the 50 non-symptomatic cases 6 (12.00%) were found infected with malaria parasite among whom 2(33.33%) had bacterial co-infection. 64% of the symptomatic patients with malaria mono-infection who took dihydroartemisinin (DHA) as monotherapeutic or combination therapy (ACT) respectively improved clinically within 24 hours after initiation of treatment. 88% of the patients with concomitant infection who took either, DHA or ACT in combination with various antibacterial improved clinically within 24 hours. After 72 hours (three day), 75% of patients with concomitant infection who used only antimalarial DHA or ACT still had mild to severe headache and fever while 91% of those in this group who used antimalarials concurrently with various antibacterials were free of all the clinical symptoms presented pre-treatment. On the 7^th day post treatment, 95% of patients with concomitant infection who used anti-malarial for three days and then antibacterial from the 4^th day and 94% of  those in  this group  who used antimalarial concurrently with  antibacterial from the commencement of treatment had all their clinical symptoms resolved

Discussion: From the results of this study, we conclude that some bacterial infection present the same clinical symptoms as malaria, as such proper laboratory check should be conducted before administration of antimalarials and that concomitant use of antimalarials with broad spectrum antibacterials is more effective in malaria chemotherapy.

Key words: Clinical efficacy; Antimalarials; Antibacterials; Concomitant Administration