Chloroquine or sulfadoxine-pyrimethamine for the treatment of uncomplicated, Plasmodium falciparurn malaria during an epidemic in Central Java, Indonesia

Authors

J. D. Maguire, U.S. Naval Medical Research Unit #2Follow
M. D. Lacy, Flagstaff Medical Center
Purworejo District Health Service (DINKES), Purworejo District Health Service (DINKES)
P. Sismadi, Ministry of Health Institute of Health Research and Development
U.S. Naval Medical Research Unit #2, U.S. Naval Medical Research Unit #2
I. Wiady, U.S. Naval Medical Research Unit #2
B. Laksana, U.S. Naval Medical Research Unit #2
M. J. Bangs, U.S. Naval Medical Research Unit #2
S. Masbar, U.S. Naval Medical Research Unit #2
I. Susanti, U.S. Naval Medical Research Unit #2
W. Basuki, U.S. Naval Medical Research Unit #2
M. J. Barcus, U.S. Naval Medical Research Unit #2
H. Marwoto, Ministry of Health Institute of Health Research and Development
M. D. Edstein, Australian Army Malaria Institute
S. Tjokrosonto, Gadjah Mada University
J. Kevin Baird, ALERTAsia FoundationFollow

Date of this Version

2002

Citation

Annals of Tropical Medicine and Parasitology, Vol. 96, No. 7, 655-668 (2002)

Comments

U.S. Government Work

Abstract

A recent malaria epidemic in the Menoreh Hills of Central Java has increased concern about the re-emergence of endemic malaria on java, which threatens the island 's 120 million residents. A 2R-uay, in-vivo test of the efficacy of treatment of malaria with antimalarial drugs was conducted among 167 villagers in the Menoreh Hills. The treatments investigated chloroquine (CQ) and sulfadoxine- pyrimethamine (SP) , constitute, respectively, the first- and second -line treatments for uncomplicated malaria in Indonesia. The prevalence of malaria among 1389 residents screened prior to enrollment was 3.l%. Treatment outcomes were assessed by microscopical diagnoses, PCR-based confirmation of the diagnoses, measurement or the whole -blood concentrations of CQ and descthylchloroquine (DCQ) , and identification of the Plasmodium falciparum genotypes. The 28-day cumulative incidences of therapeutic failure for CQ and SP were, respectively, 47% (N= 36) and 22% (N = 50) in the treatment of P. falciparum and 18%( N = 77) and 67% (N = 6) in the treatment of P. vivax. Chloroquine was thus an ineffective therapy for P. falciparurn malaria, and the presence of CQ- resistant P. Vivax and SP-resistant P. falciparum will further compromise efforts to control resurgent malaria on Java.