Research
Combined chloroquine, sulfadoxine/pyrimethamine and primaquine against Plasmodium falciparum in Central Java, Indonesia
-
* Corresponding author: Edith R Lederman erlederman@yahoo.com
1 U.S. Naval Medical Research Unit No.2, Jakarta, Indonesia
2 LITBANGKES (National Institutes of Health Research and Development), Jakarta, Indonesia
3 District Health Office, Purworejo, Central Java, Indonesia
4 Poxvirus Program, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
Malaria Journal 2006, 5:108 doi:10.1186/1475-2875-5-108
Published: 14 November 2006Abstract
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.