Abstract
BackgroundIn Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine.MethodsFrom 2009 to 2010, a non-controlled study in two hospitals in Guyana was conducted. A total 61 patients with P. vivax infection were treated with artemether-lumefantrine as a six-dose regimen twice a day for three days with additional 0.25 mg/kg/d primaquine at day 0 for 14 days. Clinical and parasitological parameters were followed on days 0,1,2,3,7,14 and 28 in agreement with WHO guidelines. Plasmodium vivax DNA from eight patients was analysed for pvmdr1, molecular marker of resistance.ResultsArtemether-lumefantrine cleared 100% of parasites on day 1, but two patients (3%) had recurrence of parasites on day 28, suggesting relapse. No pvmdr1 Y976F polymorphism was detected. The treatment regimen was well tolerated.ConclusionsIn Guyana, artemether-lumefantrine represents an adequate treatment option against P. vivax when combined with primaquine. Availability of this alternative will be of great importance in case of emerging chloroquine resistance against P. vivax.
Highlights
In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria
The number of malaria cases declined rapidly until 2007, but increased slightly in 2009, with 93% of the population still being at risk of contracting malaria [1]
This study aims to assess artemether-lumefantrine + primaquine as an alternative treatment option for P. vivax malaria, as a decline in susceptibility towards chloroquine can be predicted for the coming years
Summary
In Guyana, chloroquine + primaquine is used for the treatment of vivax malaria. A worldwide increase of chloroquine resistance in Plasmodium vivax led to questioning of the current malaria treatment guidelines. A therapeutic efficacy study was conducted using artemether-lumefantrine + primaquine against P. vivax to evaluate a treatment alternative for chloroquine. 216 million malaria cases were reported world-wide in 2010 [1]. Outside of Africa, the most widely distributed species is Plasmodium vivax, followed by Plasmodium falciparum [1]. In South America, 1–1.2 million cases of malaria are reported annually with P. vivax responsible for three quarters and P. falciparum for one quarter of cases [2]. In Guyana, 42.3% of all malaria cases between 2005 and 2009 were caused by P. falciparum and 51.3% by P. vivax. The number of malaria cases declined rapidly until 2007, but increased slightly in 2009, with 93% of the population still being at risk of contracting malaria [1].
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