Plasmodium vivax malaria: treatment of primary attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003-2004
Keywords:
Plasmodium vivax, malaria, chloroquine, primaquine, efficacy, randomized controlled trial [Publication Type]
Abstract
Introduction. Chloroquine (CQ) and primaquine (PQ) are used in Colombia for treatment of uncomplicated vivax malaria but there are few efficacy studies of this scheme.Objectives. a) to investigate the clinical picture of vivax malaria in adult patients; b) to evaluate the antimalarial treatment response to the standard scheme CQ-PQ; c) to compare the efficacy of the standard scheme and two alternative schemes with equal dose of CQ and different PQ dose; d) to identify the adverse effects of CQ-PQ treatment.
Materials and methods. Randomized, nonblind design; three groups, defined according to total dose of PQ: 45, 105 and 210 mg. All patients received CQ (1500 mg, in 48 hours), which was followed by PQ. Patients were recruited in Turbo and El Bagre. The follow-up period was 28 days. Antimalarial treatment response was classified according to the WHO-2001 protocol (early failure, late failure, adequate response).
Results. In total 228 patients were recruited, 18 were lost between days 4 and 27; the antimalarial treatment response was evaluated in 210. The clinical findings were similar to those described by other authors. Parasitaemia clearance was confirmed during the first 24 hours of CQ treatment in 11% of patients. At 48 hours 66% and at 72 hours 97% of patients were negative. All patients (210) displayed adequate treatment response to the CQ-PQ treatment. The different doses of PQ did not affect this response.
Conclusions. CQ-PQ should be conserved as the first treatment choice and should be evaluated in other areas. Simultaneous administration of CQ and PQ is proposed.
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References
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2. Carmona-Fonseca J. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 2. Iatreia 2004;17:34-53.
3. Echeverri M, Tobón A, Álvarez G, Carmona J, Blair S. Clinical and laboratory findings of Plasmodium vivax malaria in Colombia, 2001. Rev Inst Med Trop São Paulo 2003;45:29-34.
4. Ríos-Orrego A, Álvarez-Castillo T, Carmona-Fonseca J, Blair S. Evolución temporal de las plaquetas y los anticuerpos antiplaquetarios en pacientes de área endémica con malaria no complicada. An Med Interna 2005;22:561-8.
5. Blair S, Álvarez G, Campuzano G. Relación entre anemia y malaria en una población rural de Colombia. Boletín Dirección Malariología Saneamiento Ambiental 1997;37:7-13.
6. González L, Guzmán M, Carmona J, Lopera T, Blair S. Características clínico-epidemiológicas de 291 pacientes hospitalizados por malaria en Medellín (Colombia). Acta Med Colomb 2000; 25:163-70.
7. World Health Organization. The use of antimalarial drugs. Report of a WHO Informal Consultation. Geneva: WHO; 2001. WHO/CDS/RBM/2001.33. [Consulta: febrero 12 de 2006]. Disponible en: http://www.who.int/m a l a r i a / c m c _ u p l o a d / 0 / 0 0 0 / 0 1 4 / 9 2 3 /use_of_antimalarials.pdf
8. Ministerio de Salud. Guía de atención clínica para el diagnóstico y tratamiento de la malaria. Bogotá: Minsalud; 1999.
9. Soto J, Toledo J, Gutierrez P, Luzz M, Llinas N, Cedeño N, et al. Plasmodium vivax clinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 2001;65:90-3.
10. Abdon NP, Pinto AY, da Silva Rdo S, de Souza JM. Assessment of the response to reduced treatment schemes for vivax malaria. Rev Soc Bras Med Trop 2001;34:343-8.
11. da Silva RS, Pinto AY, Calvosa VS, de Souza JM. Esquemas terapêuticos encurtados para o tratamento de malária por Plasmodium vivax. Short course schemes for vivax malaria treatment. Rev Soc Bras
Med Trop 2003;36:235-9.
12. Pinto AY, Ventura AM, Calvosa VS, Silva Filho MG, Santos MA, Silva RS, et al. Eficácia de quatro esquemas terapêuticos para malaria vivax em crianças. J Pediatr 1998;74:222-7.
13. Solari-Soto L, Soto-Tarazona A, Mendoza-Requena D, Llanos-Cuentas A. Ensayo clínico del tratamiento de la malaria vivax con esquema acortado de primaquina comparado con el esquema tradicional. Rev Soc Peru Med Interna 2002;15:196-9.
14. Pinto AY, Azevedo CH, da Silva JB, de Souza JM. Assessment of chloroquine single dose treatment of malaria due to Plasmodium vivax in Brazilian Amazon. Rev Inst Med Trop Sao Paulo 2003;45:327-31.
15. Carmona-Fonseca J. Profilaxis primaria con primaquina para el paludismo: revisión. Anuario de Enfermedades Infecciosas (Medellín) 2005;2:51-4.
16. Alving AS, Arnold J, Hockwald RS, Clayman CB, Dern RJ, Beutler E, et al. Potentiation of the curative action of primaquine in vivax malaria by quinine and chloroquine. J Lab Clin Med 1955;46:301-6.
17. Edgcomb JH, Arnold J, Yount EH Jr, Alving AS, Eichelberger L, Jeffery GM, et al. Primaquine, SN 13272, a new curative agent in vivax malaria: a preliminary report. J Natl Malar Soc 1950;9:285-92.
18. World Health Organization. A general guide for the assessment of therapeutic efficacy of chloroquine for vivax malaria (working draft). Version 3. Geneva: WHO; 2001.
19. Bergqvist Y, Domeij-Nyberg B. Distribution of chloroquine and its metabolite desethyl-chloroquine in human blood cells and its implication for the quantitative determination of these compounds in serum and plasma. J Chromatogr 1983;272:137-48.
20. Whitby M. Drug resistant Plasmodium vivax malaria. J Antimicrob Chemother 1997;40:749-52.
21. Garavelli PL, Corti E. Chloroquine resistance in Plasmodium vivax: the first case in Brazil. Trans R Soc Trop Med Hyg 1992;86:128.
22. Alecrim M das C, Alecrim W, Macedo V. Plasmodium vivax resistance to chloroquine (R2) and mefloquine (R3) in Brazilian amazon region. Rev Soc Bras Med Trop 1999;32:67-8.
23. Phillips EJ, Keystone JS, Kain KC. Failure of combined chloroquine and high dose primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South America. Clin Infect Dis 1996;23:1171-3.
24. Ruebush TK 2nd, Zegarra J, Cairo J, Andersen EM, Green M, Pillai DR, et al. Chloroquine-resistant Plasmodium vivax malaria in Peru. Am J Trop Med Hyg 2003;69:548-52.
25. Baird JK, Leksana B, Masbar S, Fryauff DJ, Sutanihardja MA, Suradi L, et al. Diagnosis of resistance to chloroquine by Plasmodium vivax: timing of recurrence and whole blood chloroquine levels. Am J Trop Med Hyg 1997;56:621-6.
26. Bruce-Chwatt LJ. Essential malariology. London: William Heinemann Medical Books Ltd; 1980. p.179.
27. Mollinedo S, Mollinedo R. La malaria en Bolivia. La Paz: Ministerio de Salud y Previsión Social; 2000.p.63.
28. Pukkrittayakamee S, Vanijanonta S, Chantra A, Clemens R, White NJ. Blood stage antimalarial efficacy of primaquine in Plasmodium vivax malaria. J Infect Dis 1994;169:932-5.
29. World Health Organization. Guidelines for the treatment of malaria. Geneva: WHO; 2006. WHO/HTM/MAL/2006.1108.
30. Blair S, Tobón A, Echeverri M, Álvarez G, Carmona-Fonseca J. Adecuada respuesta clínica y parasitológica de Plasmodium vivax a la cloroquina en Colombia (Turbo, Antioquia), 2001. Infectio 2002;6:21-6.
31. Carmona-Fonseca J. Malaria, desnutrición y parasitosis intestinal en los niños colombianos: interrelaciones. Iatreia 2004;17:354-69.
32. Bloland PB. Drug resistance in malaria. Geneve: WHO; 2001. WHO/CDS/CSR/DRS/2001.4.
33. López-Antuñano FJ. Diagnóstico microscópico de los parásitos de la malaria en la sangre. En: Lopez-Antuñano FJ, Schmunis G, editores. Diagnostico de malaria. Volumen 512. Washington: OPS-OMS; 1988. p. 39-50.
34. Organización Panamericana de la Salud, Organización Mundial de la Salud. Evaluación de la eficacia terapéutica de los medicamentos para el tratamiento del paludismo por Plasmodium falciparum
sin complicaciones en las Américas. Washington: OPSOMS; 1998. OPS/HCP/HCT/113/98.
35. World Health Organization WHO. Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Geneva; WHO, 2003. Documento WHO/CDS/CSR/RMB.
36. Segura O, Maldonado CE. Las reacciones adversas a medicamentos: una aproximación desde el punto de vista económico. Biomédica 2003;23:401-7.
37. Duarte EC, Pang LW, Ribeiro LC, Fontes CJ. Association of subtherapeutic dosages of a standard drug regimen with failures in preventing relapses of vivax malaria. Am J Trop Med Hyg 2001;65:471-6.
38. Lacharme L, Carmona-Fonseca J, Tobón A, Blair S. Respuesta de P. vivax al esquema terapéutico cloroquina-primaquina en Zaragoza y Turbo, Colombia, 1998. Infectio 1998;2:90-4.
39. Castillo CM, Osorio LE, Palma GI. Assessment of therapeutic response of Plasmodium vivax and Plasmodium falciparum to chloroquine in a malaria transmission free area in Colombia. Mem Inst Oswaldo Cruz 2002;97:559-62.
40. Carmona-Fonseca J, Tobón A, Álvarez G, Blair S. El tratamiento amodiaquina-sulfadoxina-pirimetamina tiene eficacia del 98% para la malaria falciparum no complicada (Antioquia, Colombia; 2003). Iatreia 2005;18:5-26.
41. Leslie T, Rab MA, Ahmadzai H, Durrani N, Fayaz M, Kolaczinski J, et al. Compliance with 14-day primaquine therapy for radical cure of vivax malaria-a randomized placebo-controlled trial comparing
unsupervised with supervised treatment. Trans R Soc Trop Med Hyg 2004; 98:168-73.
42. Bray PG, Deed S, Fox E, Kalkanidis M, Mungthin M, Deady LW, et al. Primaquine synergises the activity of chloroquine against chloroquine-resistant P. falciparum. Biochem Pharmacol 2005;70:1158-66.
43. Cooper WC, Myatt AV, Hernandez ZT, Jeffrey GM, Coatney GR. Studies in human malaria. XXXI. Comparison of primaquine, isopentaquine, SN-3883, and pamaquine as curative agents against Chesson strain vivax malaria. Am J Trop Med Hyg 1953;2:949 57.
44. Schimidt LH. Chemotherapy of the drug-resistant malarias. Annu Rev Microbiol 1969;23:427-54.
45. Pukrittayakamee S, Imwong M, Looareesuwan S, White NJ. Therapeutic response to antimalarial and antibacterial drugs in vivax malaria. Acta Trop 2004;89:351-6.
46. Kim YR, Kuh HJ, Kim MY, Kim YS, Chung WC, Kim SI et al. Pharmacokinetics of primaquine and carboxyprimaquine in Korean patients with vivax malaria. Arch Pharm Res 2004;27:576-80.
47. Guzmán V, Carmona-Fonseca J. El citocromo P-450 y la respuesta terapéutica antimalárica. Rev Panam Salud Publica 2006;19:9-22.
2. Carmona-Fonseca J. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 2. Iatreia 2004;17:34-53.
3. Echeverri M, Tobón A, Álvarez G, Carmona J, Blair S. Clinical and laboratory findings of Plasmodium vivax malaria in Colombia, 2001. Rev Inst Med Trop São Paulo 2003;45:29-34.
4. Ríos-Orrego A, Álvarez-Castillo T, Carmona-Fonseca J, Blair S. Evolución temporal de las plaquetas y los anticuerpos antiplaquetarios en pacientes de área endémica con malaria no complicada. An Med Interna 2005;22:561-8.
5. Blair S, Álvarez G, Campuzano G. Relación entre anemia y malaria en una población rural de Colombia. Boletín Dirección Malariología Saneamiento Ambiental 1997;37:7-13.
6. González L, Guzmán M, Carmona J, Lopera T, Blair S. Características clínico-epidemiológicas de 291 pacientes hospitalizados por malaria en Medellín (Colombia). Acta Med Colomb 2000; 25:163-70.
7. World Health Organization. The use of antimalarial drugs. Report of a WHO Informal Consultation. Geneva: WHO; 2001. WHO/CDS/RBM/2001.33. [Consulta: febrero 12 de 2006]. Disponible en: http://www.who.int/m a l a r i a / c m c _ u p l o a d / 0 / 0 0 0 / 0 1 4 / 9 2 3 /use_of_antimalarials.pdf
8. Ministerio de Salud. Guía de atención clínica para el diagnóstico y tratamiento de la malaria. Bogotá: Minsalud; 1999.
9. Soto J, Toledo J, Gutierrez P, Luzz M, Llinas N, Cedeño N, et al. Plasmodium vivax clinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 2001;65:90-3.
10. Abdon NP, Pinto AY, da Silva Rdo S, de Souza JM. Assessment of the response to reduced treatment schemes for vivax malaria. Rev Soc Bras Med Trop 2001;34:343-8.
11. da Silva RS, Pinto AY, Calvosa VS, de Souza JM. Esquemas terapêuticos encurtados para o tratamento de malária por Plasmodium vivax. Short course schemes for vivax malaria treatment. Rev Soc Bras
Med Trop 2003;36:235-9.
12. Pinto AY, Ventura AM, Calvosa VS, Silva Filho MG, Santos MA, Silva RS, et al. Eficácia de quatro esquemas terapêuticos para malaria vivax em crianças. J Pediatr 1998;74:222-7.
13. Solari-Soto L, Soto-Tarazona A, Mendoza-Requena D, Llanos-Cuentas A. Ensayo clínico del tratamiento de la malaria vivax con esquema acortado de primaquina comparado con el esquema tradicional. Rev Soc Peru Med Interna 2002;15:196-9.
14. Pinto AY, Azevedo CH, da Silva JB, de Souza JM. Assessment of chloroquine single dose treatment of malaria due to Plasmodium vivax in Brazilian Amazon. Rev Inst Med Trop Sao Paulo 2003;45:327-31.
15. Carmona-Fonseca J. Profilaxis primaria con primaquina para el paludismo: revisión. Anuario de Enfermedades Infecciosas (Medellín) 2005;2:51-4.
16. Alving AS, Arnold J, Hockwald RS, Clayman CB, Dern RJ, Beutler E, et al. Potentiation of the curative action of primaquine in vivax malaria by quinine and chloroquine. J Lab Clin Med 1955;46:301-6.
17. Edgcomb JH, Arnold J, Yount EH Jr, Alving AS, Eichelberger L, Jeffery GM, et al. Primaquine, SN 13272, a new curative agent in vivax malaria: a preliminary report. J Natl Malar Soc 1950;9:285-92.
18. World Health Organization. A general guide for the assessment of therapeutic efficacy of chloroquine for vivax malaria (working draft). Version 3. Geneva: WHO; 2001.
19. Bergqvist Y, Domeij-Nyberg B. Distribution of chloroquine and its metabolite desethyl-chloroquine in human blood cells and its implication for the quantitative determination of these compounds in serum and plasma. J Chromatogr 1983;272:137-48.
20. Whitby M. Drug resistant Plasmodium vivax malaria. J Antimicrob Chemother 1997;40:749-52.
21. Garavelli PL, Corti E. Chloroquine resistance in Plasmodium vivax: the first case in Brazil. Trans R Soc Trop Med Hyg 1992;86:128.
22. Alecrim M das C, Alecrim W, Macedo V. Plasmodium vivax resistance to chloroquine (R2) and mefloquine (R3) in Brazilian amazon region. Rev Soc Bras Med Trop 1999;32:67-8.
23. Phillips EJ, Keystone JS, Kain KC. Failure of combined chloroquine and high dose primaquine therapy for Plasmodium vivax malaria acquired in Guyana, South America. Clin Infect Dis 1996;23:1171-3.
24. Ruebush TK 2nd, Zegarra J, Cairo J, Andersen EM, Green M, Pillai DR, et al. Chloroquine-resistant Plasmodium vivax malaria in Peru. Am J Trop Med Hyg 2003;69:548-52.
25. Baird JK, Leksana B, Masbar S, Fryauff DJ, Sutanihardja MA, Suradi L, et al. Diagnosis of resistance to chloroquine by Plasmodium vivax: timing of recurrence and whole blood chloroquine levels. Am J Trop Med Hyg 1997;56:621-6.
26. Bruce-Chwatt LJ. Essential malariology. London: William Heinemann Medical Books Ltd; 1980. p.179.
27. Mollinedo S, Mollinedo R. La malaria en Bolivia. La Paz: Ministerio de Salud y Previsión Social; 2000.p.63.
28. Pukkrittayakamee S, Vanijanonta S, Chantra A, Clemens R, White NJ. Blood stage antimalarial efficacy of primaquine in Plasmodium vivax malaria. J Infect Dis 1994;169:932-5.
29. World Health Organization. Guidelines for the treatment of malaria. Geneva: WHO; 2006. WHO/HTM/MAL/2006.1108.
30. Blair S, Tobón A, Echeverri M, Álvarez G, Carmona-Fonseca J. Adecuada respuesta clínica y parasitológica de Plasmodium vivax a la cloroquina en Colombia (Turbo, Antioquia), 2001. Infectio 2002;6:21-6.
31. Carmona-Fonseca J. Malaria, desnutrición y parasitosis intestinal en los niños colombianos: interrelaciones. Iatreia 2004;17:354-69.
32. Bloland PB. Drug resistance in malaria. Geneve: WHO; 2001. WHO/CDS/CSR/DRS/2001.4.
33. López-Antuñano FJ. Diagnóstico microscópico de los parásitos de la malaria en la sangre. En: Lopez-Antuñano FJ, Schmunis G, editores. Diagnostico de malaria. Volumen 512. Washington: OPS-OMS; 1988. p. 39-50.
34. Organización Panamericana de la Salud, Organización Mundial de la Salud. Evaluación de la eficacia terapéutica de los medicamentos para el tratamiento del paludismo por Plasmodium falciparum
sin complicaciones en las Américas. Washington: OPSOMS; 1998. OPS/HCP/HCT/113/98.
35. World Health Organization WHO. Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Geneva; WHO, 2003. Documento WHO/CDS/CSR/RMB.
36. Segura O, Maldonado CE. Las reacciones adversas a medicamentos: una aproximación desde el punto de vista económico. Biomédica 2003;23:401-7.
37. Duarte EC, Pang LW, Ribeiro LC, Fontes CJ. Association of subtherapeutic dosages of a standard drug regimen with failures in preventing relapses of vivax malaria. Am J Trop Med Hyg 2001;65:471-6.
38. Lacharme L, Carmona-Fonseca J, Tobón A, Blair S. Respuesta de P. vivax al esquema terapéutico cloroquina-primaquina en Zaragoza y Turbo, Colombia, 1998. Infectio 1998;2:90-4.
39. Castillo CM, Osorio LE, Palma GI. Assessment of therapeutic response of Plasmodium vivax and Plasmodium falciparum to chloroquine in a malaria transmission free area in Colombia. Mem Inst Oswaldo Cruz 2002;97:559-62.
40. Carmona-Fonseca J, Tobón A, Álvarez G, Blair S. El tratamiento amodiaquina-sulfadoxina-pirimetamina tiene eficacia del 98% para la malaria falciparum no complicada (Antioquia, Colombia; 2003). Iatreia 2005;18:5-26.
41. Leslie T, Rab MA, Ahmadzai H, Durrani N, Fayaz M, Kolaczinski J, et al. Compliance with 14-day primaquine therapy for radical cure of vivax malaria-a randomized placebo-controlled trial comparing
unsupervised with supervised treatment. Trans R Soc Trop Med Hyg 2004; 98:168-73.
42. Bray PG, Deed S, Fox E, Kalkanidis M, Mungthin M, Deady LW, et al. Primaquine synergises the activity of chloroquine against chloroquine-resistant P. falciparum. Biochem Pharmacol 2005;70:1158-66.
43. Cooper WC, Myatt AV, Hernandez ZT, Jeffrey GM, Coatney GR. Studies in human malaria. XXXI. Comparison of primaquine, isopentaquine, SN-3883, and pamaquine as curative agents against Chesson strain vivax malaria. Am J Trop Med Hyg 1953;2:949 57.
44. Schimidt LH. Chemotherapy of the drug-resistant malarias. Annu Rev Microbiol 1969;23:427-54.
45. Pukrittayakamee S, Imwong M, Looareesuwan S, White NJ. Therapeutic response to antimalarial and antibacterial drugs in vivax malaria. Acta Trop 2004;89:351-6.
46. Kim YR, Kuh HJ, Kim MY, Kim YS, Chung WC, Kim SI et al. Pharmacokinetics of primaquine and carboxyprimaquine in Korean patients with vivax malaria. Arch Pharm Res 2004;27:576-80.
47. Guzmán V, Carmona-Fonseca J. El citocromo P-450 y la respuesta terapéutica antimalárica. Rev Panam Salud Publica 2006;19:9-22.
How to Cite
1.
Carmona-Fonseca J, Álvarez G, Blair S. Plasmodium vivax malaria: treatment of primary attacks with primaquine, in three different doses, and a fixed dose of chloroquine, Antioquia, Colombia, 2003-2004. biomedica [Internet]. 2006 Sep. 1 [cited 2024 May 10];26(3):353-65. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/354
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