Therapeutic assessment of chloroquine–primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India

Abstract

BackgroundOf late there have been accounts of therapeutic failure and chloroquine resistance in Plasmodium vivax malaria especially from Southeast Asian regions. The present study was conducted to assess the therapeutic efficacy of chloroquine–primaquine (CQ–PQ) combined regimen in a cohort of uncomplicated P. vivax mono-infection.MethodsA tertiary care hospital-based prospective study was conducted among adult cohort with mono-infection P. vivax malaria as per the World Health Organization’s protocol of in vivo assessment of anti-malarial therapeutic efficacy. Participants were treated with CQ 25 mg/kg body weight divided over 3 days and PQ 0.25 mg/kg body weight daily for 2 weeks.ResultsOf a total of 125 participants recruited, 122 (97.6%) completed day 28 follow up, three (2.4%) participants were lost to follow-up. Eight patients (6.4%) were ascertained to have mixed P. vivax and Plasmodium falciparum infection by nested polymerase chain reaction test. The majority of subjects (56.8%, 71/125) became aparasitaemic on day 2 followed by 35.2% (44/125) on day 3, and 8% (10/125) on day 7, and remained so thereafter. Overall only one therapeutic failure (0.8%, 1/125) occurred on day 3 due to persistence of fever and parasitaemia.ConclusionsCQ–PQ combined regimen remains outstandingly effective for uncomplicated P. vivax malaria and should be retained as treatment of choice in the study region. One case of treatment failure indicates possible resistance which warrants constant vigilance and periodic surveillance.

Severe vivax malaria: a prospective exploration at a tertiary healthcare centre in Southwestern India

“…Concomitant infectious morbidities were precluded by attending clinicians through differential diagnoses and suggestive routine investigations including blood and urine cultures. This study was integrated to a concurrent therapeutic trial [38] of chloroquine-primaquine (CQ-PQ) combined regimen in monoinfection P. vivax acute malaria. The trial [38] included patients microscopically proven to have monoinfection of P. vivax, aged, ≥18 years, who attended KH, Manipal from September 2012 until October 2014.…”

“…This study was integrated to a concurrent therapeutic trial [38] of chloroquine-primaquine (CQ-PQ) combined regimen in monoinfection P. vivax acute malaria. The trial [38] included patients microscopically proven to have monoinfection of P. vivax, aged, ≥18 years, who attended KH, Manipal from September 2012 until October 2014. Of preliminary 161 P. vivax cases enrolled, the attending clinicians substituted CQ with artesunate combinations in 36 cases within 48 h prompting their eventual exclusion.…”

“…Despite, reasonably convincing evidence [22] of clinical severity caused by inherently pernicious P. vivax strains inoculated for treating neurosyphilis patients since early twentieth century, this species, ironically remained tagged with the term 'benign' until recently [1,12]. There have been several accounts [20,23−37] of solely obtained from every participant of the concurrent therapeutic trial [38]. Pertinent data was extracted from patients' hospital records (bedside/ambulatory) during their treatment/hospitalization.…”

Primaquine-based ionic liquids as a novel class of antimalarial hits

“…10,22 Still, the therapeutic value of primaquine is overshadowed by toxicity issues, especially to persons with glucose-6-phosphate dehydrogenase (6GPD) deciency, and by the drug's poor activity against blood-stage parasites. 10,22 Still, the therapeutic value of primaquine is overshadowed by toxicity issues, especially to persons with glucose-6-phosphate dehydrogenase (6GPD) deciency, and by the drug's poor activity against blood-stage parasites.…”

Chloroquine–Primaquine Therapeutic Efficacy, Safety, and Plasma Levels in Patients with Uncomplicated Plasmodium vivax Malaria in a Colombian Pacific Region

“…The studies conducted in other countries from 2008 to 2015 evaluated the standard treatment of CQ + PQ (28 or 42 followup days), reporting a 100% ACPR [29][30][31][32] ; studies in 2003, 2009, and 2012 reported TF rates around 1%. [33][34][35] In Colombia, studies have shown no TF with this combination. [36][37][38] The general objective of the study was to assess the therapeutic efficacy and safety of CQ combined with PQ for the treatment of uncomplicated patients with vivax malaria in a Colombian region and to measure the plasma level of CQ and its metabolite desethylchloroquine (DECQ).…”