COMPARISON OF EFFICACY OF CHLOROQUINE AND ARTEMETHER/LUMAFANTRINE IN TREATING VIVAX MALARIA IN THALL AND SURROUNDING AREA
AbstractBackground: Fever is the main complaint in patients reporting to our hospital and the most common cause of fever in our set up is malaria. The aim of this study was to know about the clinical response, efficacy and resistance of vivax malaria to chloroquine in patients reporting to Thall Scouts Hospital. Methods: All the adult male patients reporting to Thall scouts hospital with fever and other symptoms of malaria having slide positive vivax malaria were included in the study. Both thick and thin slide were used for the diagnosis and species determination of malaria. Age group of the patients was from 18–40 years old. The study was conducted for the period of two years. Results: Total number of patients included in the study was 518. Of the 518 patients, 374 (72.2%) responded to chloroquine and the remaining 144 (27.8%) were given Arthemether/Lumafantrine combination. Having positive symptoms of malaria total 374 patients treated with chloroquine 171 (45.72%) were asymptomatic after 24 hours, 98 (26.2%) after 48 hours, 78 (20.86%), after 72 hours of treatment while 27 (7.22%) were found to be resistant to chloroquine. Of the 144 patients having positive malaria treated with Artemether/Lumafantrine 62 (43.06%) were asymptomatic after 24 hours, 65 (45.14%) after 48 hours, 13 (9.03%) after 72 hours while 4 (2.78%) had still positive symptoms of malaria. Conclusion: Vivax malaria in our set up is sensitive to both Chloroquine and Arthemether/Lumafantrine. As Chloroquine is a cheap and easily available drug, so it can be safely given to patients with vivax malaria. It will also decrease the total cost of the disease. Keywords: Malaria; Vivax; Chloroquine; Artemether; Plasmodium
WHO. World malaria report 2012.Geneva: World Health Organization; 2013.
D MC. Malaria No More. Islamabad: Directorate of Malaria Control, Ministry of National Health Services; 2013.
Most H, London IM, Kane CA, Lavietes PH, Schroder EF, Hayman JM. Chloroquine for the treatment of acute attacks of vivax malaria. J Am Med Assoc 1946;131:963–7.
Rieckman KH, Davis DR, Hutton DC. Plasmodium vivaxresistance to choloroquine? Lancet 1989;2(8673):1183–4.
Sumawinata IW, Leksana B, Sutamihardja A, Subianto B, Fryauff DJ, Baird JK. Very high risk of therapeutic failure with chloroquine for uncomplicated Plasmodium falciparumandP.vivaxmalaria in Indonesian Papua. Am J Trop Med Hyg 2003;68(4):416–20.
Guthmann JP, Pittet A, Lesage A, Imwong M, Lindegardh N, Min Lwin M, et al. Plasmodium vivax resistance to chloroquine in Dawei, Southern Myanmar. Trop Med Int Health 2008;13(1):91–8.
Khatoon L, Baliraine FN, Bonizzoni M, Malik SA, Yan G. Prevalence of antimalarial drug resistance mutations inPlasmodium vivaxandP. falciparum from a malaria-endemic area of Pakistan. Am J Trop Med Hyg 2009;81(3):525–8.
Ghanchi NK, Ursing J, Beg MA, Veiga MI, Jafri S, Martensson A. Prevalence of resistance associated polymorphisms inPlasmodium falciparumfield isolates from southern Pakistan. Malar J 2011;10:18.
Leslie T, Mayan MI, Hasan MA, Safi MH, Klinkenberg E, Whitty CJ, et al. Sulfadoxine-pyrimethamine, chlorproguanil-dapsone, or chloroquine for the treatment of Plasmodium vivax malaria in Afghanistan and Pakistan: a randomized controlled trial. JAMA 2007;297(20):2201–9.
WHO. World Malaria Report 2008. Geneva: World Health Organization; 2009.
McCombie SC. Self-treatment for malaria: the evidence and methodological issues. Health Policy Plan 2002;17(4):333–44.
Pagnoni F, Convelbo N, Tiendrebeogo J, Cousens S, Esposito F. A community-based programme to provide promt and adequate treatment of presumptive malaria in children. Trans R Soc Trop Med Hyg 1997;91(5):512–7.
Kidane G, Morrow RH. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 2000;356(9229):550–5.
Müller O, Yé M, Louis VR, Sié A. Malaria in sub-Saharan Africa. Lancet 2009;373(9658):122.
Phan GT, de Vries PJ, Tran BQ, Le HQ, Nguyen NV, Nguyen TV, et al. Artemisinin or chloroquine for blood stagePlasmodium vivaxmalaria in Vietnam. Trop Med Int Health 2002;7(10):858–64.
Kurcer MA, Simsek Z, Kurcer Z. The decreasing efficacy of chloroquine in the treatment ofPlasmodium vivaxmalaria, in Sanliurfa, south-eastern Turkey. Ann Trop Med Parasitol 2006;100(2):109–13.
Soto J, Toledo J, Gutierrez P, Luzz M, Llinas N, Cedeno N, et al. Plasmodium vivaxclinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 2001;65(2):90–3.
Awab GR, Pukrittayakamee S, Imwong M, Dondorp AM, Woodrow CJ, Lee SJ, et al. Dihydroartemisinin-piperaquine versus chloroquine to treatvivaxmalaria in Afghanistan: an open randomized, non-inferiority, trial. Malar J 2010;9:105.
Nandy A, Addy M, Maji AK, Bandyopadhyay AK. Monitoring the chloroquine sensitivity ofPlasmodium vivaxfrom Calcutta and Orissa, India. Ann Trop Med Parasitol 2003;97(3):215–20.
Valecha N, Joshi H, Eapen A, Ravinderan J, Kumar A, Prajapati SK, et al. Therapeutic efficacy of chloroquine inPlasmodium vivaxfrom areaswith different epidemiological patterns in India and their Pvdhfr gene mutation pattern. Trans R Soc Trop Med Hyg 2006;100(9):831–7.
Vijaykadga S, Alker AP, Satimai W, MacArthur JR, Meshnick SR, Wongsrichanalai C. Delayed Plasmodium falciparum clearance following artesunate-mefloquine combination therapy in Thailand, 1997–2007. Malar J 2012;11(1):296.
Ketema T, Bacha K, Birhanu T, Petros B. Chloroquine-resistant Plasmodium vivax malaria in Serbo town, Jimma zone, south-west Ethiopia. Malar J 2009;8(1):177.
Djimde AA, Doumbo OK, Traore O, Guindo AB, Kayentao K, Diourte Y, et al. Clearance of drug-resistant parasites as a model for protective immunity inP. falciparum malaria. Am J Trop Med Hyg 2003;69(5):558–63.