Very High Risk of Therapeutic Failure With Chloroquine for Uncomplicated Plasmodium Falciparum and P. Vivax Malaria in Indonesian Papua

Abstract

Abstract. Chloroquine remains the first-line therapy for uncomplicated malaria in Indonesia. Among a series of trials of chloroquine for malaria on this archipelago conducted since 1990, we now report the highest risk of therapeutic failure yet observed. A clinical trial of standard chloroquine therapy for uncomplicated malaria at Arso PIR V in northeastern Indonesian Papua was conducted during 1995. We enrolled 104 non-immune subjects infected with Plasmodium falciparum (n ‫ס‬ 55), P. vivax (n ‫ס‬ 29), or P. falciparum plus P. vivax (n ‫ס‬ 20) and administered supervised standard chloroquine therapy (10 + 10 + 5 mg/kg at 24-hour intervals). The 28-day cumulative incidence of therapeutic failure was 95% for P. falciparum, 84% for P. vivax, and 100% for mixed infections. Only one subject each for P. falciparum and P. vivax remained free of parasites at day 28. All recurrent parasitemias occurred with whole blood levels of chloroquine plus desethylchloroquine exceeding 100 ng/ml. These findings document almost complete failure of chloroquine against P. falciparum or P. vivax near the northeastern coast of Indonesian Papua.

Effectiveness of Antimalarial Drugs

“…8 Elsewhere, the rates of parasitologic failure at day 28 were 57 percent (of 209 evaluations) in southwestern Asia, 46 Resistance to chloroquine by P. vivax has emerged, apparently having originated in New Guinea, where failure rates now approach 100 percent. 63 In contrast, surveys in Thailand reveal uniformly sensitive vivax malaria (not shown in Fig. 1).…”

Diagnosis and Treatment of Plasmodium vivax Malaria

“…67 High-grade CQR P. vivax has been documented on the island of New Guinea, where patients treated with CQ have been observed to have early clinical deterioration requiring hospitalization, delayed parasite clearance, and early recurrent parasitaemia. 46,68,69 Evidence for declining CQ efficacy against P. vivax, albeit to a lesser degree, has been reported from across the vivax-endemic world (Figures 1-3). [70][71][72] In vivo efficacy.…”

Short Report: Polymorphisms in the Chloroquine Resistance Transporter Gene in Plasmodium Falciparum Isolates From Lombok, Indonesia

“…6 In Indonesia, the first cases of resistance were reported in the early 1970s from Kalimantan and Irian Jaya. Although resistance has been reported on several islands in Indonesia, 7 with resistance as high as 95% for P. falciparum and 84% for P. vivax, 8 CQ continues to be the first-line treatment of P. falciparum and P. vivax malaria because of its safety and availability at very low cost. Here we examined the prevalence of polymorphisms in the pfmdr1 and pfcrt genes in 48 P. falciparum isolates from the West Lombok District of Indonesia.…”