The drug sensitivity and transmission dynamics of human malaria on Nias Island, North Sumatra, Indonesia

Fryauff, David J.; Leksana, B; Masbar, S; Wiady, Iwa; Sismadi, Priyanto; Susanti, Augustina I.; Nagesha, Hadya S.; Syafruddin, Syafruddin; Atmosoedjono, Soeroto; Bangs, Michael J.; Baird, J. Kevin

doi:10.1179/000349802125001249

Cited by 28 publications

(42 citation statements)

References 31 publications

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“…Similar surveys in central and western Indonesia, however, revealed relatively low risk (<20%) [3,11-15]. The apparent isolation of high risk of CRPV to Indonesian New Guinea encouraged health authorities to maintain chloroquine as the national first-line therapy for vivax malaria.…”

Section: Discussionmentioning

confidence: 96%

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Evaluation of chloroquine therapy for vivax and falciparum malaria in southern Sumatra, western Indonesia

Sutanto

Endawati

Ling

et al. 2010

Malar J

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BackgroundChloroquine was used as first-line treatment for Plasmodium falciparum or Plasmodium vivax in Indonesia before the initial launch of artemisinin combination therapy in 2004. A study to evaluate efficacies of chloroquine against P. falciparum and P. vivax was undertaken at Lampung in southern Sumatra, western Indonesia in 2002.MethodsPatients infected by P. falciparum or P. vivax were treated with 25 mg/kg chloroquine base in three daily doses over 48 hr. Finger prick blood was collected on Days 0, 2, 3, 7, 14, 21 and 28 after starting drug administration. Whole blood chloroquine and its desethyl metabolite were measured on Days-0, -3 and -28, or on the day of recurrent parasitaemia.Results42 patients infected by P. falciparum were enrolled, and 38 fullfilled criteria for per protocol analysis. Only six of 38 (16%) showed a response consistent with senstivity to chloroquine. 25 of 32 failures were confirmed resistant by demonstrating chloroquine levels on day of recurrence exceeding the minimally effective concentration (200 ng/mL whole blood). The 28-day cumulative incidence of resistance in P. falciparum was 68% (95% CI: 0.5260 - 0.8306). Thirty one patients infected by P. vivax were enrolled, and 23 were evaluable for per protocol analysis. 15 out of 23 (65%) subjects had persistent or recurrent parasitaemia. Measurement of chloroquine levels confirmed all treatment failures prior to Day-15 as resistant. Beyond Day-15, 4 of 7 recurrences also had drug levels above 100 ng/mL and were classified as resistant. The 28-day cumulative incidence of chloroquine resistance in P. vivax was 43% (95% CI: 0.2715 - 0.6384).ConclusionThese findings confirm persistantly high levels of resistance to chloroquine by P. falciparum in southern Sumatra, and suggest that high-grade and frequent resistance to chloroquine by P. vivax may be spreading westward in the Indonesia archipelago.

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Section: Discussionmentioning

confidence: 96%

“…Evidence from the western islands of Indonesia between 1992 until 1998, revealed relatively low risk (approx. 10%) of chloroquine- resistant P. vivax [3,11-15]. Nonetheless, in 2008 national treatment policy was changed to apply artesunate-amodiaquine as first-line therapy for vivax malaria throughout Indonesia.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of chloroquine therapy for vivax and falciparum malaria in southern Sumatra, western Indonesia

Sutanto

Endawati

Ling

et al. 2010

Malar J

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show abstract

“…However, all 38 subjects evaluated on a small, isolated island in Papua had infections with sensitive organisms (52). In western Indonesia two separate surveys at Nias, near northern Sumatra, found 9 inadequate responses among 49 subjects (18%) (16,50). A survey of 54 subjects in Indonesian Borneo revealed that 22% of the isolates were CRPV (53).…”

Section: Geographic Range Of Resistancementioning

confidence: 99%

Chloroquine Resistance inPlasmodium vivax

Baird

2004

Antimicrob Agents Chemother

310

239

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“…8 Studies in Southeast Asia indicated that the rates of parasitologic failure at day 7 and day 28 were 36 percent and 49 percent, respectively. [74][75][76][77][78][79] Good efficacy (80 percent) persisted elsewhere -in southwestern Asia and on the Horn of Africa, where no parasitologic failures were reported among 362 evaluations 80,81 ; in southern Asia, where the failure rate was 18 percent (of 339 evaluations) by day 28 [55][56][57] ; and in South America, where the failure rate was 9 percent (of 50 evaluations) by day 7, 14 percent (of 42 evaluations) by day 14, and 6 percent (of 119 evaluations) by day 28. [82][83][84] The risk of resistance to sulfadoxine-pyrimethamine is relatively high in Southeast Asia and eastern Africa.…”

Section: Drug Resistancementioning

confidence: 99%