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Simvastatin Enhances Clinical Response of Patients to Sulfadoxine-Pyrimethamine in Falciparum Malaria

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Background: Doubts have been raised concerning the therapeutic efficacy of sulfadoxine-pyrimethamine due to poor clinical response necessitating the need for continuous monitoring and further advocating for the replacement of sulfadoxine-pyrimethamine with suitable alternatives. Statins are known to down regulate biosynthesis of dolichol and isoprenoid pyrophosphate, inhibiting in vitro growth of Plasmodium falciparum..

Objectives: This study was aimed at evaluating the clinical response of simvastatin plus sulfadoxine-pyrimethamine  combination as compared to sulfadoxine-pyrimethamine alone in the chemotherapy of malaria.

Methods: Malaria patients (n=60) confirmed by thick blood film and immunological tests were selected and informed written consent obtained. Patients were categorized into simvastatin plus sulfadoxine-pyrimethamine (test) and sulfadoxine-pyrimethamine alone (control). The University of Nigeria Teaching Hospital Research Ethics Committee  reviewed the proposal and provided ethical clearance certification (NHREC/05/01/2008B). The WHO was adopted in the assessment of clinical response and patients followed up on days D0, D3, D7, D14 and D28 post-treatment. The analysis of data was done using GraphPad Prism 4.0 and data presented in tabular and graphical forms. 

Results: The mean early treatment failure given as 9.2±0.26% in the test group was significantly decreased relative to 20.5±0.26% in the control; whereas mean late treatment failure given as 10.3±0.15%  in the test group was reported relative to 23.6±0.22% in the control. There was statistically significant increase in  adequate clinical and parasitological response given as 77.5±0.59% in the test group relative to 55.9±0.49% in the control. The mean parasite clearance time and fever clearance time given in the test group as 4.4±0.2 days and 55.3±2.6 hours were significantly reduced relative to 9.8±0.2 days and 87.4±4.5 hours recorded in the control. The clinical clearance rate given as 82.3±0.8% was significantly increased in the test group relative to 60±1.3% recorded in controls. A statistically significant decrease was recorded in the recrudescence rate given as 19.1±0.14% in the test group relative to 39 ± 0.22% recorded in the control. 

23 Nov, 2015
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e-Published: 18 Feb, 2016


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