Chloroquine versus Sulfadoxine-Pyrimethamine for Treatment of Plasmodium falciparum Malaria in Savannakhet Province, Lao People's Democratic Republic: An Assessment of National Antimalarial Drug Recommendations

The in vivo efficacies of the Lao People's Democratic Republic (Laos) nationally recommended antimalarial agents—chloroquine and sulfadoxine-pyrimethamine—were assessed in a randomized, comparative trial that involved 100 patients with uncomplicated Plasmodium falciparum malaria who were follow...

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Bibliographic Details
Published in:Clinical infectious diseases 2003-10, Vol.37 (8), p.1021-1028
Main Authors: Mayxay, Mayfong, Newton, Paul N., Khanthavong, Maniphono, Tiengkham, Pongvongsa, Phetsouvanh, Rattanaxay, Phompida, Samlane, Brockman, Alan, White, Nicholas J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Animals
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimalarials
Antimalarials - therapeutic use
Antiparasitic agents
Biological and medical sciences
Chloroquine - therapeutic use
Diseases
Drug Combinations
Drug Resistance
Falciparum malaria
Female
Health Planning Guidelines
Hematocrit
Human protozoal diseases
Humans
Infections
Infectious diseases
Laos - epidemiology
Major Articles
Malaria
Malaria, Falciparum - drug therapy
Male
Medical sciences
Medical treatment failures
Parasitemia
Parasites
Parasitic diseases
Parasitology
Pharmacology. Drug treatments
Protozoal diseases
Pyrimethamine - therapeutic use
Sulfadoxine - therapeutic use
Treatment Failure
Treatment Outcome
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Summary:The in vivo efficacies of the Lao People's Democratic Republic (Laos) nationally recommended antimalarial agents—chloroquine and sulfadoxine-pyrimethamine—were assessed in a randomized, comparative trial that involved 100 patients with uncomplicated Plasmodium falciparum malaria who were followed for 42 days after starting treatment. Despite a shorter mean time to fever clearance associated with administration of chloroquine (mean time to clearance, 35.6 h; 95% confidence interval [CI], 26.3–45.0 h), compared with that associated with sulfadoxine-pyrimethamine (61.1 h; 95% CI, 50.9–71.3 h; P < .001), treatment failures were twice as frequent among patients receiving chloroquine therapy than among those receiving sulfadoxine-pyrimethamine therapy (36% vs. 18%; P = .02). Of 23 treatment failures, 10 (43%) were high grade. Treatment failure rates among children (age range, 5–15 years) were 4.9 times higher (95% CI, 2–12) than those among adults (P < .0001). Gametocytemia after antimalarial treatment was associated with receipt of sulfadoxine-pyrimethamine therapy and with treatment failure (P = .009). The efficacy of both chloroquine and sulfadoxine-pyrimethamine in Laos is unsatisfactory.
ISSN:1058-4838
1537-6591
DOI:10.1086/377734