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Reports from several sites in South America suggest the presence of isolated cases of chloroquine-resistant Plasmodium vivax malaria. To investigate the possibility of chloroquine-resistant P. vivax in Peru, we conducted 28-day in vivo drug efficacy trials at three sites in the Amazon region and one site on the northern Pacific Coast between 1998 and 2001. A total of 242 patients between the ages of 2 and 60 years were enrolled (177 from the Amazon region and 65 from the northern coast). All subjects received directly observed therapy with chloroquine, 25 mg/kg, over a three-day period. On enrollment, 49% had a documented fever and 96% had a history of fever; their geometric mean parasite density was 5,129 parasites/µL. A total of 212 (88%) of the 242 subjects completed their 28-day follow-up. Four of the 177 patients from the Amazon region had a recurrence of P. vivax parasitemia on days 21 and 28 after treatment was initiated. Two of these patients had chloroquine-resistant infections, based on polymerase chain reaction-single-stranded conformational polymorphism genotyping and chloroquine-desethylchloroquine blood levels, which were 
97 ng/mL at the time of the reappearance of parasitemia. None of the subjects studied on the northern Pacific Coast had recurrent parasitemia.
Received January 3, 2003. Accepted for publication May 14, 2003.
Acknowledgments: We thank the staff of the Padre Cocha, Moronacocha, Caballococha, and Bellavista Health Centers and the Hospital de Apoyo Iquitos for their assistance with the enrollment, treatment, and follow-up of patients, and Drs. Carlos Calampa and Ana Maria Palacios, without whose support these studies would not have been possible. Drs. Kevin Baird and Alan Magill provided technical assistance for the study in Padre Cocha. Malaria microscopy was conducted by Carola Salas, Julio Figueroa, Ever Alvarez, Anibal Sanchez, and Dolores Rimarachin. Christian Bautista carried out the data analysis.
Financial support: These studies were supported by the U.S. Naval Medical Research and Development Command, National Naval Medical Center (Bethesda, MD), Work Unit No. 847705 82000 25GB B0016 GEIS Lima. Kevin C. Kain was supported by a Canada Research Chair from the Canadian Institutes of Health Research and a career award from the Ontario Ministry of Health.
Authors’ addresses: Trenton K. Ruebush II, Division of Parasitic Diseases, Mailstop F-22, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-3604 Fax: 770-488-4203 E-mail: tkr1{at}cdc.gov. Jorge Zegarra, Javier Cairo, Ellen M. Andersen, Coralith Garcia, and Lely Solary, U.S. Naval Medical Research Center Detachment, Unit 3800, APO AA 34031, Lima, Peru. Michael Green, Entomology Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341. Dylan Pillai and Kevin C. Kain, Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, EN G-224, Toronto, Ontario, Canada M59 2C4. Wilmer Marquiño, Maria Huilca, and Ernesto Arévalo, Instituto Nacional de Salud, Capac Yupanqui, 1400, Jesus Maria 11, Lima, Peru.
Reprint requests: Trenton K. Ruebush II, U.S. Naval Medical Research Center Detachment, Unit 3800, APO AA 34031, Lima, Peru.
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