Abstract
BackgroundSeveral reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India.MethodFive PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days) plus PQ (210 mg over 14 days) regimen was carried out in accordance with the World Health Organization’s protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort.ResultsIn total, 161 participants were recruited in the study of which, 155 (96.3%) participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%). Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity) was noted among 5 (3.1%) participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28%) cases as mixed (vivax and falciparum) malaria.ConclusionsThe CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs.
Highlights
India is one of the main contributors to global burden of Plasmodium vivax malaria
Glucose6-phosphate dehydrogenase deficiency (G6PDd,
G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with glucose-6-phosphate dehydrogenase (G6PD) 1.4 U/g Hb due to PLOS ONE | DOI:10.1371/journal.pone
Summary
India is one of the main contributors to global burden of Plasmodium vivax malaria. The national guideline [1] recommends, chloroquine (CQ) dosage as 25 mg/kg body weight over three days along with primaquine (PQ) as 0.25 mg/kg body weight daily over 14 days for the treatment of all uncomplicated P. vivax malaria in non-pregnant adults and children aged over one year with normal glucose-6-phosphate dehydrogenase (G6PD) activity. In-vivo clinical evaluation remains the mainstay of monitoring the antimalarial therapeutic efficacy in P. vivax malaria and should be employed once every two years [7, 8]. Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India
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