VERY HIGH RISK OF THERAPEUTIC FAILURE WITH CHLOROQUINE FOR UNCOMPLICATED PLASMODIUM FALCIPARUM AND P. VIVAX MALARIA IN INDONESIAN PAPUA

Authors

Iwa W. Sumawinata, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia
Provincial Health Service, Abepura, Papua, Indonesia, Provincial Health Service, Abepura, Papua, Indonesia
Budhi Leksana, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia
Awalludin Sutamihardja, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia
U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, Indonesia
Budi Subianto, Provincial Health Service, Abepura, Papua, Indonesia
Infectious Disease Research Center, Ministry of Health, Jakarta, Indonesia, Infectious Disease Research Center, Ministry of Health, Jakarta, Indonesia
David J. Fryauff, Malaria Program, Naval Medical Research Center, Silver Spring, MDFollow
J. Kevin Baird, U.S. Naval Medical Research Unit No. 2, American Embassy, Jakarta, IndonesiaFollow

Date of this Version

2003

Citation

Am. J. Trop. Med. Hyg., 68(4), 2003, pp. 416–420

Comments

U.S. Government Work

Abstract

Chloroquine remains the first-line therapy for uncomplicated malaria in Indonesia. Among a series of trials of chloroquine for malaria on this archipelago conducted since 1990, we now report the highest risk of therapeutic failure yet observed. A clinical trial of standard chloroquine therapy for uncomplicated malaria at Arso PIR V in northeastern Indonesian Papua was conducted during 1995. We enrolled 104 non-immune subjects infected with Plasmodium falciparum (n=55), P. vivax (n=29), or P. falciparum plus P. vivax (n=20) and administered supervised standard chloroquine therapy (10 + 10 + 5 mg/kg at 24-hour intervals). The 28-day cumulative incidence of therapeutic failure was 95% for P. falciparum, 84% for P. vivax, and 100% for mixed infections. Only one subject each for P. falciparum and P. vivax remained free of parasites at day 28. All recurrent parasitemias occurred with whole blood levels of chloroquine plus desethylchloroquine exceeding 100 ng/ml. These findings document almost complete failure of chloroquine against P. falciparum or P. vivax near the northeastern coast of Indonesian Papua.