Combined chloroquine, sulfadoxine/pyrimethamine and primaquine against Plasmodium falciparum in Central Java, Indonesia.

Abstract

BACKGROUND:

Chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) monotherapy for Plasmodium falciparum often leads to therapeutic failure in Indonesia. Combining CQ with other drugs, like SP, may provide an affordable, available and effective option where artemisinin-combined therapies (ACT) are not licensed or are unavailable.

METHODS:

This study compared CQ (n = 29 subjects) versus CQ + SP (with or without primaquine; n = 88) for clinical and parasitological cure of uncomplicated falciparum malaria in the Menoreh Hills region of southern Central Java, Indonesia. Gametocyte clearance rates were measured with (n = 56 subjects) and without (n = 61) a single 45 mg dose of primaquine (PQ).

RESULTS:

After 28 days, 58% of subjects receiving CQ had cleared parasitaemia and remained aparasitaemic, compared to 94% receiving CQ combined with SP (p < 0.001). Msp-2 genotyping permitted reinfection-adjusted cure rates for CQ and CQ combined with SP, 70% and 99%, respectively (p = 0.0006).

CONCLUSION:

Primaquine exerted no apparent affect on cure of asexual stage parasitaemia, but clearly accelerated clearance of gametocytes. CQ combined with SP was safe and well-tolerated with superior efficacy over CQ for P. falciparum parasitaemia in this study.

• Authors: Edith R Lederman, Jason D Maguire, Iwa W Sumawinata, Krisin Chand, Iqbal Elyazar, Lusi Estiana, Priyanto Sismadi, Michael J Bangs, J Kevin Baird
• Journal: Malaria journal (Malar J) Vol. 5 Pg. 108 (Nov 14 2006) ISSN: 1475-2875 [Electronic] England
• PMID: 17105658 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Antimalarials
• Drug Combinations
• fanasil, pyrimethamine drug combination
• Sulfadoxine
• Chloroquine
• Primaquine
• Pyrimethamine

Topics

• Adolescent
• Adult
• Animals
• Antimalarials (administration & dosage, therapeutic use)
• Chloroquine (administration & dosage, therapeutic use)
• Drug Combinations
• Drug Therapy, Combination
• Female
• Humans
• Indonesia (epidemiology)
• Malaria, Falciparum (drug therapy, epidemiology)
• Male
• Middle Aged
• Plasmodium falciparum
• Primaquine (administration & dosage, therapeutic use)
• Pyrimethamine (administration & dosage, therapeutic use)
• Sulfadoxine (administration & dosage, therapeutic use)