Malaria Journal

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Open Access Research

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

Edith R Lederman4,1*, Jason D Maguire1, Iwa W Sumawinata1, Krisin Chand1, Iqbal Elyazar1, Lusi Estiana3, Priyanto Sismadi2, Michael J Bangs1 and J Kevin Baird1

Author Affiliations

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

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Malaria Journal 2006, 5:108 doi:10.1186/1475-2875-5-108

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.