Research

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

Edith R Lederman^1,4 , Jason D Maguire¹ , Iwa W Sumawinata^{1^} , 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

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.