Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can Chloroquine or Sulfadoxine-Pyrimethamine Be Reintroduced in Combination with Artesunate

N.M. Huong, Timothy Davis, J. Cox-Singh, S. Hewitt, T.Q. Toan, T.B. Kim, N.T. Hanh, V.N. Phuong, D.H. Nhan, L.D. Cong

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    Abstract

    The effectiveness of chloroquine or sulfadoxine-pyrimethamine administered with artesunate for treating uncomplicated falciparum malaria was assessed in 2 Vietnamese provinces where the sensitivity of parasites in vitro to conventional therapies had increased with the removal of drug pressure. In the province of Dac Lac, where potential malaria exposure begins at birth, 57 subjects (mean age, 9.6 years) were randomized to receive artesunate-chloroquine (group 1) or artesunate-sulfadoxine-pyrimethamine (group 2). In the province of Binh Phuoc, 66 nonimmune workers and their relatives (mean age, 24.2 years) were similarly randomized. By day 28 of follow-up, >96% of Dac Lac patients and <52% of Binh Phuoc patients in group 1 and group 2 had an in vivo response that demonstrated sensitivity to therapy. PCR-confirmed cure rates paralleled in vivo results among patients in Binh Phuoc, but PCR results identified 9 (15.7%) of the Dac Lac patients as having experienced asymptomatic, submicroscopic recrudescences. In Dac Lac, pfcrt K76T was near fixation, but infection with parasites with this mutation predicted recrudescence among group 1 patients in Binh Phuoc. Common pfdhfr mutations did not predict outcome in group 2. The successful reintroduction of conventional therapies in combination with artesunate depends on epidemiological and/or parasitological factors.
    Original languageEnglish
    Pages (from-to)1461-1466
    JournalClinical Infectious Diseases
    Volume37
    Issue number11
    DOIs
    Publication statusPublished - 2003

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    Falciparum Malaria
    Vietnam
    Chloroquine
    Therapeutics
    Recurrence
    Polymerase Chain Reaction
    Mutation
    Parasitic Diseases
    Malaria
    Parasites
    pyrimethamine drug combination fanasil
    artesunate
    Parturition
    Pressure
    Pharmaceutical Preparations

    Cite this

    Huong, N.M. ; Davis, Timothy ; Cox-Singh, J. ; Hewitt, S. ; Toan, T.Q. ; Kim, T.B. ; Hanh, N.T. ; Phuong, V.N. ; Nhan, D.H. ; Cong, L.D. / Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can Chloroquine or Sulfadoxine-Pyrimethamine Be Reintroduced in Combination with Artesunate. In: Clinical Infectious Diseases. 2003 ; Vol. 37, No. 11. pp. 1461-1466.
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    abstract = "The effectiveness of chloroquine or sulfadoxine-pyrimethamine administered with artesunate for treating uncomplicated falciparum malaria was assessed in 2 Vietnamese provinces where the sensitivity of parasites in vitro to conventional therapies had increased with the removal of drug pressure. In the province of Dac Lac, where potential malaria exposure begins at birth, 57 subjects (mean age, 9.6 years) were randomized to receive artesunate-chloroquine (group 1) or artesunate-sulfadoxine-pyrimethamine (group 2). In the province of Binh Phuoc, 66 nonimmune workers and their relatives (mean age, 24.2 years) were similarly randomized. By day 28 of follow-up, >96{\%} of Dac Lac patients and <52{\%} of Binh Phuoc patients in group 1 and group 2 had an in vivo response that demonstrated sensitivity to therapy. PCR-confirmed cure rates paralleled in vivo results among patients in Binh Phuoc, but PCR results identified 9 (15.7{\%}) of the Dac Lac patients as having experienced asymptomatic, submicroscopic recrudescences. In Dac Lac, pfcrt K76T was near fixation, but infection with parasites with this mutation predicted recrudescence among group 1 patients in Binh Phuoc. Common pfdhfr mutations did not predict outcome in group 2. The successful reintroduction of conventional therapies in combination with artesunate depends on epidemiological and/or parasitological factors.",
    author = "N.M. Huong and Timothy Davis and J. Cox-Singh and S. Hewitt and T.Q. Toan and T.B. Kim and N.T. Hanh and V.N. Phuong and D.H. Nhan and L.D. Cong",
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    Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can Chloroquine or Sulfadoxine-Pyrimethamine Be Reintroduced in Combination with Artesunate. / Huong, N.M.; Davis, Timothy; Cox-Singh, J.; Hewitt, S.; Toan, T.Q.; Kim, T.B.; Hanh, N.T.; Phuong, V.N.; Nhan, D.H.; Cong, L.D.

    In: Clinical Infectious Diseases, Vol. 37, No. 11, 2003, p. 1461-1466.

    Research output: Contribution to journalArticle

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    AU - Davis, Timothy

    AU - Cox-Singh, J.

    AU - Hewitt, S.

    AU - Toan, T.Q.

    AU - Kim, T.B.

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    AU - Cong, L.D.

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    AB - The effectiveness of chloroquine or sulfadoxine-pyrimethamine administered with artesunate for treating uncomplicated falciparum malaria was assessed in 2 Vietnamese provinces where the sensitivity of parasites in vitro to conventional therapies had increased with the removal of drug pressure. In the province of Dac Lac, where potential malaria exposure begins at birth, 57 subjects (mean age, 9.6 years) were randomized to receive artesunate-chloroquine (group 1) or artesunate-sulfadoxine-pyrimethamine (group 2). In the province of Binh Phuoc, 66 nonimmune workers and their relatives (mean age, 24.2 years) were similarly randomized. By day 28 of follow-up, >96% of Dac Lac patients and <52% of Binh Phuoc patients in group 1 and group 2 had an in vivo response that demonstrated sensitivity to therapy. PCR-confirmed cure rates paralleled in vivo results among patients in Binh Phuoc, but PCR results identified 9 (15.7%) of the Dac Lac patients as having experienced asymptomatic, submicroscopic recrudescences. In Dac Lac, pfcrt K76T was near fixation, but infection with parasites with this mutation predicted recrudescence among group 1 patients in Binh Phuoc. Common pfdhfr mutations did not predict outcome in group 2. The successful reintroduction of conventional therapies in combination with artesunate depends on epidemiological and/or parasitological factors.

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