Chloroquine or sulfadoxine-pyrimethamine for the treatment of uncomplicated, Plasmodium falciparum malaria during an epidemic in Central Java, Indonesia.

Abstract	A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on Java, which threatens the island's 120 million residents. A 28-day, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 167 villagers in the Menoreh Hills. The treatments investigated, chloroquine (CQ) and sulfadoxine-pyrimethamine (SP), constitute, respectively, the first- and second-line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 33%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement of the whole-blood concentrations of CQ and desethylchloroquine (DCQ), and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N = 36) and 22% (N = 50) in the treatment of P. falciparum, and 18% (N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparum malaria, and the presence of CQ-resistant P. vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.
Authors	J D Maguire, M D Lacy, Sururi, P Sismadi, Krisin, I Wiady, B Laksana, M J Bangs, S Masbar, I Susanti, W Basuki, M J Barcus, H Marwoto, M D Edstein, S Tjokrosonto, J K Baird
Journal	Annals of tropical medicine and parasitology (Ann Trop Med Parasitol) Vol. 96 Issue 7 Pg. 655-68 (Oct 2002) ISSN: 0003-4983 [Print] England
PMID	12537627 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References	Antimalarials Drug Combinations fanasil, pyrimethamine drug combination Sulfadoxine Chloroquine Pyrimethamine
Topics	Adolescent Adult Aged Animals Antimalarials (therapeutic use) Child Child, Preschool Chloroquine (therapeutic use) Disease Outbreaks Drug Combinations Drug Resistance Female Humans Incidence Indonesia (epidemiology) Malaria, Falciparum (drug therapy, epidemiology, parasitology) Male Middle Aged Prevalence Pyrimethamine (therapeutic use) Sulfadoxine (therapeutic use) Treatment Failure

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