Abstract
To evaluate the extent of chloroquine underdosing and to measure the concentrations of chloroquine and desethylchloroquine in adult patients with P. vivax malaria in the Brazilian Amazon basin. Prospective study of cases in male adult patients with malaria by Plasmodium vivax treated with a total dose of 1500mg chloroquine over three days and a short course of primaquine. Patients were weighed at admission, and the dose per mg/kg was determined. Blood samples were collected at 24 and 168h after enrolment, and the concentrations of chloroquine and desethylchloroquine were measured in plasma by high-performance liquid chromatography with fluorescence detection. Of 61 patients were included in the study, and 60% received a total dose of chloroquine below 25mg/kg. Plasma chloroquine concentrations ranged from 90 to 184ng/ml and from 175 to 827ng/ml at 24 and 168hours. For desethylchloroquine, the values ranged from 32 to 144ng/ml and from 90 to 440ng/ml at 24 and 168h. There were no significant correlations between the plasma levels of chloroquine and the doses administered (mg/kg) at 24 and 196h. Similar results were found for desethylchloroquine. There is widespread suboptimal dosing of chloroquine that is probably due to the dosing regimen based on patient age, which reduces the drug exposure with a possible influence on parasite clearance.
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