Therapeutic response of multidrug-resistant Plasmodium falciparum and P. vivax to chloroquine and sulfadoxine-pyrimethamine in southern Papua, Indonesia.

Journal article

To determine the level of antimalarial drug resistance in southern Papua, Indonesia, we assessed the therapeutic efficacy of chloroquine plus sulfadoxine-pyrimethamine (CQ+SP) for Plasmodium falciparum infections as well as CQ monotherapy for P. vivax infections. Patients with P. falciparum failing therapy were re-treated with unsupervised quinine+/-doxycycline therapy and those with P. vivax with either unsupervised quinine+/-doxycycline or amodiaquine. In total, 143 patients were enrolled in the study (103 treated with CQ+SP and 40 with CQ). Early treatment failures occurred in four patients (4%) with P. falciparum and six patients (15%) with P. vivax. The failure rate by Day 28 for P. vivax was 65% (95% CI 49-81). After PCR correction for re-infections, the Day 42 recrudescence rate for P. falciparum infections was 48% (95% CI 31-65). Re-treatment with unsupervised quinine+/-doxycycline resulted in further recurrence of malaria in 48% (95% CI 31-65) of P. falciparum infections and 70% (95% CI 37-100) of P. vivax infections. Eleven patients with recurrent P. vivax were re-treated with amodiaquine; there were no early or late treatment failures. In southern Papua, a high prevalence of drug resistance of P. falciparum and P. vivax exists both to first- and second-line therapies. Preliminary data indicate that amodiaquine retains superior efficacy compared with CQ for CQ-resistant P. vivax.

Authors: Ratcliff, A; Siswantoro, H; Kenangalem, E; Wuwung, M; Brockman, A

• Publication status: Published
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene
• Volume: 101
• Issue: 4
• Pages: 351-359
• Publication date: 2007-04-01
• DOI: 10.1016/j.trstmh.2006.06.008
• EISSN: 1878-3503
• ISSN: 0035-9203
• Language: English
• Keywords: Female; Adolescent; Recurrence; Malaria, Vivax; Treatment Outcome; Plasmodium vivax; Malaria, Falciparum; Animals; Male; Sulfadoxine; Aged; Infant; Middle Aged; Humans; Child; Aged, 80 and over; Prospective Studies; Pyrimethamine; Chloroquine; Adult; Drug Resistance, Multiple; Drug Combinations; Drug Therapy, Combination; Child, Preschool; Antimalarials; Treatment Failure; Plasmodium falciparum