Monitoring of the therapeutic efficacy of chloroquine for the treatment of uncomplicated,Plasmodium falciparummalaria in Iran

Abstract

Between 2002 and 2004, the standardized 28-day protocol recently developed by the World Health Organization was used to explore the efficacy of chloroquine, in the treatment of uncomplicated, Plasmodium falciparum malaria, in five sentinel sites in southern Iran. All but 14 of the 158 patients enrolled (128, 28 and two from the provinces of Sistan-Baluchestan, Hormozgan and Kerman, respectively) were successfully followed-up. The overall frequency of treatment failure by day 28 was 78.5%, with 17.4% of the patients being classed as early treatment failures, 34.7% as late clinical failures, and 26.4% as late parasitological failures. There appeared to be no significant change in the frequency of treatment failure between the 2002-2003 and 2003-2004 transmission seasons, nor any significant between-site variation in the efficacy of chloroquine. Given these observations, the replacement of chloroquine, as the first-line drug for the treatment of uncomplicated, P. falciparum malaria in Iran, was inevitable. Artesunate-sulfadoxine-pyrimethamine is now the recommended first-line treatment, with artemether-lumefantrine used for second-line treatment. The efficacies of these combination therapies are currently being evaluated and monitored.

Association of pfcrt But Not pfmdr1 Alleles with Chloroquine Resistance in Iranian Isolates of Plasmodium falciparum

“…The high prevalence of CQ treatment failure by D28 (78.5%) in south-eastern province of Iran was also reported in another study. 6 Therefore, the present data suggest that these 4 mutations in the pfcrt gene might have been selected by treatment and therefore can be used as molecular markers to monitor CQR in this region of the world.…”

“…An in vivo study carried out by Raeisi and co-workers during 2002-2004 also showed that the frequency of treatment failure by day 28 was 78.5% in south-eastern provinces of Iran. 6 Although resistance to CQ has been well documented, this anti-malarial drug is still used as the standard treatment of uncomplicated malaria in many geographic regions. Some progress has been made in understanding the mechanism of action of CQ, but it has not yet been fully understood.…”

High prevalence of pfdhfr–pfdhps triple mutations associated with anti-malarial drugs resistance in Plasmodium falciparum isolates seven years after the adoption of sulfadoxine–pyrimethamine in combination with artesunate as first-line treatment in Iran

“…In Iran, the burden of malaria has declined gradually from 96, 340 in 1991 to 15,712 total cases in 2007, and further reduction was reported in 2013, with total cases of 1,373 due to the scaling-up of different interventions (CDMC, Tehran, Iran, unpublished data). Resistance to CQ was reported in Sistan and Baluchistan Province in 1983 (Edrissian et al, 1986), and this resistance was increased to more than 78.5% of treatment failures in this area (Raeisi et al, 2006). As the intensity of CQ resistance increased, in 2005, the country changed the CQ, as first-line antimalarial treatment, to a combination of SP-CQ and artemetherlumefantrine (CoArtem Ò ), as the second-line drug (Zakeri et al, 2008).…”

Seasonal Abundance and Host-Feeding Patterns of Anopheline Vectors in Malaria Endemic Area of Iran

“…During the last six years, 15000 to 25000 cases have been reported each year in Iran and more than 85% of them occurred in the south and southeast of Iran (Department of communicable Disease Control). The current annual parasite index (API) is 7 per 1000 inhabitants in the endemic area [5]. Several factors, such as presence of insecticide resistance among vectors [6], parasite drug resistance [7], and socioeconomical problems and population movement [5, 8], have made eradication in this area so difficult.…”