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Resistance to Chloroquine by Plasmodium vivax at Alor in the Lesser Sundas Archipelago in Eastern Indonesia

The therapeutic response to standard chloroquine therapy against Plasmodium vivax was evaluated in 36 subjects living at Alor in the Lesser Sundas Archipelago of eastern Indonesia. Chloroquine level were measured on 32 individuals, and showed evidence of adequate absorption of standard chloroquine therapy. Three subjects failed treatment by Day 2 or 3, with evidence of rising asexual parasitemia, and two others had stable parasitemia to Day 7. Ten more subjects had recurrent parasitemia by Day 14, two by Day 21, and another one by Day 28. Three subjects had recurrent parasitemia on Days 14 and 28, but with chloroquine < 100 ng/mL. Eleven subjects cleared parasitemia by Day 3 and had no recurrences up to Day 28. In summary, 28-day cumulative incidence of confirmed resistance to chloroquine was 56% of infections evaluated. Chloroquine should not be considered adequate for treatment of acute vivax malaria acquired in this region.

Received May 29, 2008. Accepted for publication April 15, 2009.

Acknowledgments: The authors thank Dr. P. Rückert and GTZ/SISKES administrative staff in Kupang and Alor for kind support and cooperation. We also thank staff of the Kenarilang Health Center (Drs. Andi Medianto and Made Birawan and all nurses, laboratory technicians and field workers) who participated in this study and Dr. J. D. Maguire and B. Leksana for providing HPLC facilities at the US Naval Medical Research Unit #2 in Jakarta.

Financial support: This study was supported by the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ), Improvement of the District Health System in East Nusa Tenggara (GTZ/SISKES).

^* Address correspondence to Inge Sutanto, Department of Parasitology, Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No 6, Jakarta 10430, Indonesia. E-mail: sutanto.inge{at}yahoo.com

Authors’ addresses: Inge Sutanto, Department of Parasitology, Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No 6, Jakarta 10430, Indonesia, E-mail: sutanto.inge{at}yahoo.com. Sri Suprijanto, Communicable Disease Control, Ministry Health of Indonesia, Jalan Percetakan Negara No 29, Jakarta 10560, Indonesia, E-mail: srisp_lab{at}yahoo.com. Nurhayati, Department of Parasitology, Faculty of Medicine, University of Andalas, Jalan Perintis Kemerdekaan, Padang 25127, Indonesia, Tel: 62-0751-31746, E-mail: nurhayatikaidir{at}yahoo.co.id. Paul Manoempil, Timor Leste Asistensia Integrado Saude (TAIS), Delegasi Saude (USAID), rua Bairo Formoza, Dili, Timor Leste, Tel: 670-735-1962, E-mail: manumpilps{at}yahoo.com. J. Kevin Baird, Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No 69, Jakarta 10430, Indonesia, E-mail: kbaird{at}eocru.org.

Reprint requests: Inge Sutanto, Department of Parasitology, Faculty of Medicine, University of Indonesia, Jalan Salemba Raya No 6, Jakarta 10430, Indonesia, Tel: 62-21-3102135, Fax: 62-21-39832018, E-mail: sutanto.inge{at}yahoo.com.