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

Authors

Edith R. Lederman, U.S. Naval Medical Research Unit # 2Follow
Jason D. Maguire, U.S. Naval Medical Research Unit # 2Follow
Iwa W. Sumawinata, U.S. Naval Medical Research Unit # 2
Krisin Chand, U.S. Naval Medical Research Unit # 2Follow
Iqbal Elyazar, U.S. Naval Medical Research Unit # 2Follow
Lusi Estiana, District Health OfficeFollow
Priyanto Sismadi, LITBANGKESFollow
Michael J. Bangs, U.S. Naval Medical Research Unit # 2Follow
J. Kevin Baird, U.S. Naval Medical Research Unit # 2Follow

Date of this Version

2006

Citation

Published in Malaria Journal (2006) 5:108. DOI:10.1186/1475-2875-5-108.

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.