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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.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).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).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.

Original publication

DOI

10.1186/1475-2875-5-108

Type

Journal article

Journal

Malaria journal

Publication Date

14/11/2006

Volume

5

Addresses

US Naval Medical Research Unit No.2, Jakarta, Indonesia. erlederman@yahoo.com

Keywords

Animals, Humans, Plasmodium falciparum, Malaria, Falciparum, Sulfadoxine, Pyrimethamine, Chloroquine, Primaquine, Drug Combinations, Antimalarials, Drug Therapy, Combination, Adolescent, Adult, Middle Aged, Indonesia, Female, Male