Madam, The spread of chioroquine resistant malaria in endemic areas has been reported widely^1-3. Incidence of chlomqume resistance have also beenon the rise inPakistan^4,5 and have necissitated the use of alternative anti-malarials.
Halofantrine hydrochloride is an anti-malarial effective against falciparum andvivax malaria. The efficacy of this drug has been reported in earlier investigations^6-12. in this study, the efficacy of halofantrine for treatment of falciparum malaria after nine years of general use inPakistan is described.
Seventy hospitalized patients suffenngfromfalciparum malaria were included in the study. Age of the patients ranged from 2-70 years (mean 14.7 years). Diagnosis was confirmed by peripheral film examination and parasitaemia count was calculated as number of red blood cells infected per thousand blood cells. Laboratory investigations included complete CP, urineDR, liverfunctiontests andblood urea. Temperature was recorded before start of treatment and then every 4 hours for 7 days. Parasitaemia count was monitored before start of treatment and then daily for 7 days. Patient follow up was carried out for four weeks. Symptoms observed in patients included fever (70 patients), chills with paroxysms (45 patients) and splenomegaly (24 patients).
Adults were given three doses of halofantrine 500 mg at six hourly intervals and children were given three doses of 8 mg per kg body weight at 6 hourly intervals. 2 patients suffering from cerebral malaria were not treated with Halfan. Parasite count was reduced significantly within 24 hours of treatment in 68 patients. Six cases showed parasitaemia even after 72 hours of treatment but parnsitaemia was cleared in all patients after 96 hours. Nearly 50% of patients were afebnle after 40 hours. All 68 patients were afebrile within 80 hours.
No serious side effects were observed. Vomiting after start of treatment xas reported in 6 patients but generally halofantrine was well tolerated. Relapse was not seen in any patient during follow up. Our results indicate that halofanthne is an effective drug for treatment of falciparum malaria.

Muhammad Yousaf, Muhammad Bilal
DHQ Hospital, Dera Ghazi Khan.

1. Soro, B., Davis, CE., Peyron, F.M. eta!. Formulation ofmalaria treatmentpolicy of children in Coted ‘Ivoire’ as chloroquine resistant Plasmodium Falciparum spreads into West Africa. Ann. Trop. Med. Parasitol., 1989;83: 101.106.
2. Teklehaimanot. A. Chioroquine resistant Plasmodium Falciparum malaria in Ethopia. Lancet, 1986;ii: 127-129.
3. Watkins, W.M., Lury, J.D., Kariuki, D. et al. Efficacy of multiple-dose halofantrine in treatment of chloroquine resistant falciparum malaria in children in Kenya. Lancet, 1988;ii:247-250.
4. Rab, SM., Saeed, M., Mabmood. S. eta!. The efficacy andsafety of Halofantrine Hydrochloride in acute malaria. Parasitol., 1989;5 :37-44.
5. Salahuddin, N., Ahmad, S. Haider, T. et al. Efficacy and safety of Halofantrine hydrochloride in the treatment of acute malaria. Infect. Dis. J., 1997,4:11-12.
6. Wirima, J., Khoromana, C., Molyneux, M.E. et al. Clinical trials with halofantrine hydrochloride in Malawi. Lancet, 1988;2 :250- 252.
7. Anabwani, GM. EsamaiFO. andMenya. D.A. A ran domized controlled trial to assess the relative efficacy of chioroqurne, amodiaqwne, halofantrine and fansidar in the treatmentofuncomplicated malaria in children. E Aft. Med. J.,1996;73: 155-158.
8. Boudrea, E.F., Pang, LW., Dixon, K.E. et al. Malaria treatment efficacy of halofantrine (WR 171, 669) in initial trials in Thailand. Bull. WHO., 1988;66:227-235.
9. Conlaud, J.P, Le Bras, J., Matheron, S. et al. Treatment of imported cases of falciparum malaria in France with halofantrine. Trans. Roy. Soc. Trop. Med. Hyg.. 1986;80:6 15-617.
10. Consgriff, T.M, Boudreau, E.F., Pamplin, Cl. et al. Evaluation of the antimalarial activity of the phenanthrene methanol halofantrine (WR 171,669). Am. J. Trop. Med. Hyg., 1982;31 :1075- 1079.
11. Falade, CO., Salako, LM, Sowunmi A. eta!. Comparative efficacy of halofantrinc, chloroquine and sulphadoxine pyrimethamine for treatment of acute uncomplicated malaria in Nigerian children. Trans. R,Soc. Trop. Mod. Hyg., 1997;91 :58-62.