Dr. Murai Éva szerk.: Parasitologia Hungarica 26. (Budapest, 1993)

investigations: sugar, urea nitrogen, total creatinine, direct and indirect bilirubin, aspartate and alanine aminotransferases. The urine was analyzed for sugar, protein, urobilinogen and haemoglobin, and was examined microscopically for the presence of leucocytes. Haematological, biochemical and urine analysis were performed on days 0, 5 and 10. Dill-Glazko test of the urine and immunofluorescent antibody test of the sera were performed before the start of treatment. Electrocardiography (ECG) was performed in groups 1 and 2 before starting the treatment and 3 hours after swallowing the first dose of drugs. X-ray examination was made once, upon admission. The body temperature was taken at 7 a.m. and at 11 and 19 p.m. every day. Blood pressure and pulse rate were recorded at the same time. At 11 a.m. the blood pressure was measured while the patients were lying in bed, standing up, and after they had been in standing position for 3 minutes. In group 2, the level of quinidine was measured on day 0,2 and 4 before the morning dose. The limited facilities did not allow the performance of microtests to assess the in vitro susceptibility of parasites to different antimalarial drugs. RESULTS In group la four patients and in group lb six patients were cured by chloroquine + verapamil treatment Parasitaemia was not eliminated by this treatment in 6 patients from group la and in 4 patients from group lb. They showed different degrees of resistance to chloroquine (in vivo RI, RII and RIII). These 10 patients were included in group 2a and 48 hours after the failure of chloroquin + verapamil therapy they received a quinine + quinidine combination (300 mg of quinine sulphate and 200 mg of quinidine sulphate in sugar-coated tablets). All patients were cured. The mean parasite clearance time in this group was 57.4 hours. The mean fever clearance time was 38.8 hours on the average. Neither side effects nor recrudescence were seen after this treatment during the observation period. Patients in group 2b were treated with the same standard dose of quinine + quinidine once. These patients had not received any antimalarial treatment previously. Their urine proved negative by the Dill-Glazko test. The mean parasite clearance time was 55.06 hours, and the mean fever clearance time was 36.7 hours. All patients we re cured. No side effects were seen. Only one patient had a moderate bradycardia (60/min) on the 4th day of treatment. No pathological conduction time was seen (PQ was 0.16 sec and Qlc corrected to heart rate was normal). It was not necessary to stop the treatment. The third group contained 10 patients treated with quinine sulphate at a daily dose of 30 mg/kg. The mean parasite clearance time was 92.8 hours, while the mean fever clearance time was 69.1 hours. No side effects were seen. One patient had a recrudescence on the 8th day and he was successfully treated with the quinine + quinidine combination. Group 4 contained 10 patients who were treated with chloroquine sulphate only. One patient had to be excluded from the study because he left the hospital before having completed the therapeutic regimen. Only 3 patients were cleared of parasites and fever, which represents a 33.3 % cure rate (Table 1).