Malaria Journal
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ResearchCombined chloroquine, sulfadoxine/pyrimethamine and primaquine against Plasmodium falciparum in Central Java, IndonesiaEdith R Lederman1,4 , Jason D Maguire1 , Iwa W Sumawinata1^ , Krisin Chand1 , Iqbal Elyazar1 , Lusi Estiana3 , Priyanto Sismadi2 , Michael J Bangs1 and J Kevin Baird1  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 author email corresponding author email^Deceased
Malaria Journal 2006,
5:108doi:10.1186/1475-2875-5-108
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| Published: |
14 November 2006 |
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. |