TY - JOUR
T1 - Evaluation of chloroquine therapy for vivax and falciparum malaria in southern Sumatra, western Indonesia
AU - Sutanto, Inge
AU - Endawati, Dedeh
AU - Ling, Liem Hui
AU - Laihad, Ferdinand
AU - Setiabudy, Rianto
AU - Baird, J. Kevin
N1 - Funding Information:
We thank Dr PR Arbani for making this study possible, Dr Heri Joko Subandrio and staff of Lampung provincial health office and Endah Setyaningrum from University of Lampung for kind support and cooperation. We also thank Parlentar Naibaho for reading malaria blood smears, staffs of the Hanura Health Center (Dr Reny Indrayani, Ida Manuli, Eti Martini, Heni Suryani, Lies Setyaningsih, Retno Setyawati, Khairulah Nasution) for their dedicated field work, and Dr JD Maguire and B Leksana for providing HPLC facilities and Purnomo Projodipuro for cross-checking malaria blood smears at the US Naval Medical Research Unit #2 in Jakarta. The kind help from Kasia Stepniewska for statistical consultation is very much appreciated. Financial support: This study was supported by WHO SEARO, New Delhi. This manuscript was prepared in part through participation in a course on scientific writing organized and sponsored by the Southeast Asian Infectious Diseases Clinical Research Network, and the authors gratefully acknowledge that support.
PY - 2010
Y1 - 2010
N2 - Background. Chloroquine was used as first-line treatment for Plasmodium falciparum or Plasmodium vivax in Indonesia before the initial launch of artemisinin combination therapy in 2004. A study to evaluate efficacies of chloroquine against P. falciparum and P. vivax was undertaken at Lampung in southern Sumatra, western Indonesia in 2002. Methods. Patients infected by P. falciparum or P. vivax were treated with 25 mg/kg chloroquine base in three daily doses over 48 hr. Finger prick blood was collected on Days 0, 2, 3, 7, 14, 21 and 28 after starting drug administration. Whole blood chloroquine and its desethyl metabolite were measured on Days-0, -3 and -28, or on the day of recurrent parasitaemia. Results. 42 patients infected by P. falciparum were enrolled, and 38 fullfilled criteria for per protocol analysis. Only six of 38 (16%) showed a response consistent with senstivity to chloroquine. 25 of 32 failures were confirmed resistant by demonstrating chloroquine levels on day of recurrence exceeding the minimally effective concentration (200 ng/mL whole blood). The 28-day cumulative incidence of resistance in P. falciparum was 68% (95% CI: 0.5260 - 0.8306). Thirty one patients infected by P. vivax were enrolled, and 23 were evaluable for per protocol analysis. 15 out of 23 (65%) subjects had persistent or recurrent parasitaemia. Measurement of chloroquine levels confirmed all treatment failures prior to Day-15 as resistant. Beyond Day-15, 4 of 7 recurrences also had drug levels above 100 ng/mL and were classified as resistant. The 28-day cumulative incidence of chloroquine resistance in P. vivax was 43% (95% CI: 0.2715 - 0.6384). Conclusion. These findings confirm persistantly high levels of resistance to chloroquine by P. falciparum in southern Sumatra, and suggest that high-grade and frequent resistance to chloroquine by P. vivax may be spreading westward in the Indonesia archipelago.
AB - Background. Chloroquine was used as first-line treatment for Plasmodium falciparum or Plasmodium vivax in Indonesia before the initial launch of artemisinin combination therapy in 2004. A study to evaluate efficacies of chloroquine against P. falciparum and P. vivax was undertaken at Lampung in southern Sumatra, western Indonesia in 2002. Methods. Patients infected by P. falciparum or P. vivax were treated with 25 mg/kg chloroquine base in three daily doses over 48 hr. Finger prick blood was collected on Days 0, 2, 3, 7, 14, 21 and 28 after starting drug administration. Whole blood chloroquine and its desethyl metabolite were measured on Days-0, -3 and -28, or on the day of recurrent parasitaemia. Results. 42 patients infected by P. falciparum were enrolled, and 38 fullfilled criteria for per protocol analysis. Only six of 38 (16%) showed a response consistent with senstivity to chloroquine. 25 of 32 failures were confirmed resistant by demonstrating chloroquine levels on day of recurrence exceeding the minimally effective concentration (200 ng/mL whole blood). The 28-day cumulative incidence of resistance in P. falciparum was 68% (95% CI: 0.5260 - 0.8306). Thirty one patients infected by P. vivax were enrolled, and 23 were evaluable for per protocol analysis. 15 out of 23 (65%) subjects had persistent or recurrent parasitaemia. Measurement of chloroquine levels confirmed all treatment failures prior to Day-15 as resistant. Beyond Day-15, 4 of 7 recurrences also had drug levels above 100 ng/mL and were classified as resistant. The 28-day cumulative incidence of chloroquine resistance in P. vivax was 43% (95% CI: 0.2715 - 0.6384). Conclusion. These findings confirm persistantly high levels of resistance to chloroquine by P. falciparum in southern Sumatra, and suggest that high-grade and frequent resistance to chloroquine by P. vivax may be spreading westward in the Indonesia archipelago.
UR - http://www.scopus.com/inward/record.url?scp=77749311669&partnerID=8YFLogxK
U2 - 10.1186/1475-2875-9-52
DO - 10.1186/1475-2875-9-52
M3 - Article
C2 - 20152016
AN - SCOPUS:77749311669
SN - 1475-2875
VL - 9
JO - Malaria Journal
JF - Malaria Journal
IS - 1
M1 - 52
ER -
