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Am. J. Trop. Med. Hyg., 80(6), 2009, pp. 914-918
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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Efficacy of Artemisinin-Based Combination Therapy for Treatment of Persons with Uncomplicated Plasmodium falciparum Malaria in West Sumba District, East Nusa Tenggara Province, Indonesia, and Genotypic Profiles of the Parasite

Puji B. S. Asih, Rita M. Dewi, Sekar Tuti, Mohamad Sadikin, Wajio Sumarto, Bonar Sinaga, Andre J. A. M. van der Ven, Robert W. Sauerwein, AND Din Syafruddin*
Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Biomedic Program, Graduate Program in Faculty of Medicine, and Department of Biochemistry, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia; of Biochemistry, West Sumba District Health Department, Waikabubak, West Sumba District, Indonesia; University Medical Centre St. Radbound, Nijmegen, The Netherlands; Department of Parasitology, Faculty of Medicine, Hasanuddin University, Makasar, Indonesia

Reports on treatment failures associated with the use of first-and second-line antimalarial drugs chloroquine and sulfadoxine-pyrimethamine have recently increased in many parts of Indonesia. The present study evaluated artemisinin-based combination therapy for treatment of persons with uncomplicated Plasmodium falciparum malaria in West Sumba District, East Nusa Tenggara Province. A total of 103 persons 1–57 years of age were enrolled, given standard artesunate-amodiaquine therapy, and followed-up for 28 days. All persons clinically recovered, but two persons were again parasitemic on day 7. This finding indicated that these two persons had recurrent parasitemias on days 21 and 28. Molecular analyses suggested both recurrences were caused by reinfections. There were no severe adverse events, but complaints of gastrointestinal upset, nausea and vomiting, and headache linked to therapy occurred among 9.7%, 5.8% and 5.8% of the persons, respectively. Artesunate-amodiaquine proved efficacious therapy for treatment of persons with uncomplicated P. falciparum malaria at one site in eastern Indonesia but it may have tolerability problems that merit further investigation.

Received November 22, 2008. Accepted for publication March 6, 2009.

Acknowledgments: We thank Professor S. Marzuki (Eijkman Institute for Molecular Biology) for encouragement and support; Dr. Kevin Baird (Eijkman-Oxford Clinical Research Unit, Jakarta) and Dr. Michael Kinzer (Naval Medical Research Unit No. 2, Jakarta) for critically reading the manuscript; and Sili Bouka (director of Karitas Hospital), Dr. Oktavian Decky, the health professional staff at Karitas Hospital, and Puskesmas Lahihuruk for assistance during sample collection.

Financial support: This study is part of the doctoral program at the University of Indonesia through the PRIOR program for malaria in Indonesia and was supported by a grant-in-aid from the Netherlands Foundation for the advancement of Tropical Research and the Netherlands Foundation for Health Research and Development.

* Address correspondence to Din Syafruddin, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia. E-mail: din{at}eijkman.go.id

Authors’ addresses: Puji B. S. Asih, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia, E-mail: puji{at}eijkman.go.id. Rita M. Dewi and Sekar Tuti, National Institute of Health Research and Development, Ministry of Health, Jalan Percetakan Negara, Jakarta, Indonesia, E-mails: marleta{at}litbang.depkes.go.id and sekartuti{at}litbang.depkes.go.id. Mohamad Sadikin, Department of Biochemistry, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia, E-mail: mosadik{at}yahoo.fr. Wajio Sumarto and Bonar Sinaga, West Sumba District Health Department, Waikabubak, West Sumba District, East Nusa Tenggara Province, Indonesia, E-mails: wajios{at}yahoo.com and bonarsinaga{at}yahoo.com. Andre J. A. M. van der Ven and Robert W. Sauerwein, University Medical Centre St Radboud, 6500 HB, Nijmegen, The Netherlands, E-mails: A.vanderVen{at}AIG.umcn.nl and R.Sauerwein{at}mmb.umcn.nl. Din Syafruddin, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia, and Department of Parasitology, Faculty of Medicine, Hasanuddin University, Jalan Perintis, Kemerdekaan Km 10, Makassar 90245, Indonesia, E-mail: din{at}eijkman.go.id.

Reprint requests: Din Syafruddin, Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta 10430, Indonesia, E-mail: din{at}eijkman.go.id.






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