Journal Article

Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can Chloroquine or Sulfadoxine-Pyrimethamine Be Reintroduced in Combination with Artesunate?

Nguyen Mai Huong, Timothy M. E. Davis, Janet Cox-Singh, Sean Hewitt, Tran Quoc Toan, Tran Bach Kim, Nguyen Thi Hanh, Vo Nhu Phuong, Doan Hanh Nhan and Le Dinh Cong

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 11, pages 1461-1466
Published in print December 2003 | ISSN: 1058-4838
Published online December 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/379323
Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can Chloroquine or Sulfadoxine-Pyrimethamine Be Reintroduced in Combination with Artesunate?

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The effectiveness of chloroquine or sulfadoxine-pyrimethamine administered with artesunate for treating uncomplicated falciparum malaria was assessed in 2 Vietnamese provinces where the sensitivity of parasites in vitro to conventional therapies had increased with the removal of drug pressure. In the province of Dac Lac, where potential malaria exposure begins at birth, 57 subjects (mean age, 9.6 years) were randomized to receive artesunate-chloroquine (group 1) or artesunate-sulfadoxine-pyrimethamine (group 2). In the province of Binh Phuoc, 66 nonimmune workers and their relatives (mean age, 24.2 years) were similarly randomized. By day 28 of follow-up, >96% of Dac Lac patients and <52% of Binh Phuoc patients in group 1 and group 2 had an in vivo response that demonstrated sensitivity to therapy. PCR-confirmed cure rates paralleled in vivo results among patients in Binh Phuoc, but PCR results identified 9 (15.7%) of the Dac Lac patients as having experienced asymptomatic, submicroscopic recrudescences. In Dac Lac, pfcrt K76T was near fixation, but infection with parasites with this mutation predicted recrudescence among group 1 patients in Binh Phuoc. Common pfdhfr mutations did not predict outcome in group 2. The successful reintroduction of conventional therapies in combination with artesunate depends on epidemiological and/or parasitological factors.

Journal Article.  3633 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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