TREATMENT OF SYMPTOMATIC VIVAX MALARIA IN BANGKA

UNSPECIFIED (2005) TREATMENT OF SYMPTOMATIC VIVAX MALARIA IN BANGKA. Project Report. Pusat Penelitian dan Pengembangan Pemberantasan Penyakit.

Abstract

Background: Amodiaquine (AQ) showed very effective for treatment of symptomatic vivax malaria in Bangka. The combination of artesunate (ATS) and AQ was effective for treatment of uncomplicated falciparum malaria in Africa. This combination is a potential combination for both treatments of uncomplicated falciparum and vivax malaria in Indonesia. Combination of artemisinin (ART) and piperaquine (PPQ) is promising for future use because it is highly effective and safe, simple, and relatively cheap. We therefore canied out this trial to provide evidence whether the therapeutic efficacies of a :Hfay single daily dose regimen of combined ATS and AQ (ATS3+AQ3) were similar to a 2-day single daily dose regimen of ART and PPQ (ART2+PPQ2 )in both falciparum and vivax malaria. Patients and methods: This trial was a prospective evaluation and a comparative study of the therapeutic efficacy of 3-day single daily dose regimen of combined ATS (4 mg/kg bw/dose) and AQ (25 mg base/kg bw in 3 days), and a 2-day single daily dose of ART (2.5 mglkg bw/dose) and PPQ (15 mg/kg bw/dose) in uncomplicated falciparum and vivax malaria patients based on the new version of 2003 WHO protocol. The trial enrolled each arm 88 cases with a total of 176 uncomplicated falciparum malaria and 176 vivax malaria assuming proportion of treatment failures of both regimens were similar to 5% within confidence level of 95% and the precision of 5%. Patients were randomized, stratified by age (children and adults), and observed for 28 days. The primary endpoint was Adequate Clinical and Parasitological Response (ACPR) corrected by PCR. Analysis was by evaluability and intention to treat analysis. Findings: The therapeutic efficacies of ATS3+AQ3 and ART2+PPQ2 were not different and effective for treatment of falciparum malaria and vivax malaria. Both regimens had high ACPR of >90%, means of Fever Clearance Time and Parasite Clearance Time of <1.5 days, hemoglobin recovery of >95%, persistent gametocyte caniage in falciparum malaria patients over day 7, and common adverse reactions were nausea and vomiting to ATS3+AQ3 and ART2+PPQ2. Interpretation: ATS3+AQ3 and ART2+PPQ2 were safe, tolerated, and efficacious for the treatment of falciparum malaria and vivax malaria. Primaquine should be given for radical cure as earlier as possible. Cost remains a problem for malaria control.

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