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In terms of drug resistance Bangladesh acts as an important gateway to the Indian Subcontinent. However, little is known about the current status of drug resistance in this country. The aim of this study was therefore to determine the therapeutic efficacy as well as in vitro drug sensitivity of quinine for 3 days plus a single dose of sulfadoxine/pyrimethamine (Q3F), an affordable alternative to the previously used chloroquine, for the treatment of uncomplicated falciparum malaria. Sixty-three patients were enrolled in the study; the overall cure rate in a 42-day follow-up after PCR adjustment was 87.3% (95% CI: 77.6–94.1). One patient was classified as early treatment failure (1.7%, 95% CI: 0.0–8.9%); 6 patients (10%; 95% CI: 3.8–20.5%) had late treatment failures within a median time of 27 days. HRP2 in vitro drug sensitivity tests were performed on all samples. Significantly higher (P = 0.008) in vitro IC50s for pyrimethamine in treatment failures reflect the somewhat compromised drug sensitivity to this drug. These data suggest that the combination of 3 days of quinine with a single dose of sulfadoxine/pyrimethamine is an interesting and affordable alternative as long as or whenever ACT is not available.
Received March 9, 2006. Accepted for publication May 13, 2006.
Acknowledgments: The study was conducted at the ICDDR,B: Centre for Health and Population Research with the support of grants from the U.S. Department of Defense Global Emerging Infections System (GEIS) program, and the Austrian Science Fund Project No. 15754-B02. ICDDR,B acknowledges with gratitude the commitment of U.S. Department of Defense Global Emerging Infections System (GEIS) program, and the Austrian Science Fund to the Centre’s research effort. We also express our gratitude to the team of BRAC for their excellent support in the fieldwork. We also thank the laboratory and clinic staff of the Chakaria field station for their help, and last but not least the local community for their cooperation.
Disclaimer: The opinions or assertions contained herein are the private views of the author, and are not to be construed as official, or as reflecting true views of the Department of the Army or the Department of Defense.
* Address correspondence to Harald Noedl, Department of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna Kinderspitalgasse 15 A-1090 Vienna, Austria. E-mail: harald.noedl{at}meduniwien.ac.at
Authors’ addresses: Kamala Thriemer, Bernhard Attlmayr, and Harald Noedl, Department of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria. Rashidul Haque, Yukiko Wagatsuma, and Selim Akhter, Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka-1212, Bangladesh. Mohammed Abdus Salam, BRAC Bangladesh, 75 Mohakhali, Dhaka 1212, Bangladesh. Mark Fukuda, Kurt Schaecher, and R. Scott Miller, Armed Forces Research Institute of Medical Sciences, 316/6 Rajvithi Road, Bangkok 10400, Thailand.
Reprint requests: Harald Noedl, Department of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspital-gasse 15, A-1090 Vienna, Austria. Telephone: 43-1-4277-64882, Fax: 43-1-4277-64889, E-mail: harald.noedl{at}meduniwien.ac.at.
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