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A Trial of CI-564 (Dapolar®), a Repository Antimalarial for Prophylaxis in Amapá, Brazil
Hermelino H. Gusmão
Hermelino H. Gusmão
Health Division, ICOMI, Department of Epidemiology, School of Hygiene and Public Health, University of São Paulo, Rio de Janeiro, Brazil
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Edmundo Juarez
Edmundo Juarez
Health Division, ICOMI, Department of Epidemiology, School of Hygiene and Public Health, University of São Paulo, Rio de Janeiro, Brazil
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CI-564 (Dapolar®), a mixture of cycloguanil pamoate and diacetyldiamino-diphenylsulfone (DADDS), was used as a repository antimalarial in a test of its suppressive and prophylactic effectiveness. Children of 12 years of age or less, in an area of endemic malaria in the Amazon valley in Brazil, were treated; CI-564 was given to 300 children and CI-564 plus amodiaquin to 300 children; 300 other children to whom no suppressive medication was given served as a control. Initial CI-564 injections were repeated twice at 4-month intervals, and children who had also received amodiaquin were given single doses of this drug with the second and third injections. In the group that received CI-564, ring forms of Plasmodium falciparum disappeared from the peripheral blood within 3 days, and all circulating forms of Plasmodium vivax within 7 days. Throughout the trial there was no significant difference between the treated groups in the prevalence of parasitemia, while there was significantly more parasitemia in the control group. CI-564 alone or with amodiaquin exerted a significant prophylactic effect against both P. falciparum and P. vivax infections. During the 4-month follow-up periods between injections, there were 22 instances of breakthrough by P. falciparum, of which 18 (81%) occurred 90 to 120 days after the previous injection. No breakthrough by P. vivax occurred before Day 90, while there were 39 failures thereafter. Local reactions to CI-564 injections were moderate and transitory, induration and tenderness being most common. There were no allergic reactions after the second and third injections. We conclude that CI-564 can be a practical prophylactic against malaria in suitable situations.
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