1921
Volume 100, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

In Colombia, published studies for the treatment of uncomplicated malaria with chloroquine–primaquine (CQ-PQ) are scarce. The aim of the study was to evaluate the therapeutic efficacy and safety profile of this combination. A clinical trial was performed in adults with uncomplicated malaria using the 28-day World Health Organization validated protocol. Patients received supervised antimalarial treatment and the primary efficacy end point was the clinical and parasitological response. Safety was assessed through adverse events surveillance, and plasma levels of antimalarial drugs were measured. A total of 77 patients were included. Adequate clinical and parasitological response rate diagnosed by thick blood smear examination was achieved in 72 of 73 patients (98.6%) with a complete 28-day follow-up. There were two parasitological therapeutic failures (TFs) (2.9%) on day 28, established by polymerase chain reaction among 68 patients, one of them with a positive film. No adverse events were detected. After completing the antimalarial treatment, all patients reached adequate plasma concentrations of CQ and desethylchloroquine (DECQ), with medians of 302.9 and 104.0 ng/mL, respectively. Uncomplicated malaria treatment with CQ–PQ standard treatment was effective and safe in the study population; TFs were not associated with low plasma levels of CQ and DECQ.

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References

  1. WHO 2017. World Malaria Report 2017. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/world-malaria-report-2017/report/en/. Accesed August 25, 2018. [Google Scholar]
  2. Instituto Nacional de Salud 2017. Boletín Epidemiológico Semanal Semana 52 2017. Available at: http://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2017 Boletín epidemiológico semana 52.pdf. Accesed August 25, 2018.
  3. WHO 2016. World Malaria Report 2016. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/world-malaria-report-2017/report/en/. Accesed August 25, 2018. [Google Scholar]
  4. Fasinu PS, Tekwani BL, Avula B, Chaurasiya ND, Nanayakkara NP, Wang YH, Khan IA, Walker LA, , 2016. Pathway-specific inhibition of primaquine metabolism by chloroquine/quinine. Malar J 15: 466. [Google Scholar]
  5. Pukrittayakamee S, 2014. Pharmacokinetic interactions between primaquine and chloroquine. Antimicrob Agents Chemother 58: 33543359. [Google Scholar]
  6. Instituto Nacional de Salud, Bogotá, 2010. Ministerio de protección Social República de Colombia, Organizacion Panamericana de la salud OPS/OMS, 2010. Guía para la Atención Clínica Integral del Paciente con Malaria. [Google Scholar]
  7. WHO 2018. Antimalarial Drug Efficacy and Drug Resistance. Available at: http://www.who.int/malaria/areas/treatment/drug_efficacy/en/.
  8. Rieckmann KH, Davis DR, Hutton DC, , 1989. Plasmodium vivax resistance to chloroquine? Lancet 2: 11831184. [Google Scholar]
  9. Phan GT, De Vries PJ, Tran BQ, Le HQ, Nguyen NV, Nguyen TV, Heisterkamp SH, Kager PA, , 2002. Artemisinin or chloroquine for blood stage Plasmodium vivax malaria in Vietnam. Trop Med Int Health 7: 858864. [Google Scholar]
  10. Dua VK, Kar PK, Sharma VP, , 1996. Chloroquine resistant Plasmodium vivax malaria in India. Trop Med Int Health 1: 816819. [Google Scholar]
  11. Marlar T, Myat Phone K, Aye Yu S, Khaing Khaing G, Ma S, Myint O, , 1995. Development of resistance to chloroquine by Plasmodium vivax in Myanmar. Trans R Soc Trop Med Hyg 89: 307308. [Google Scholar]
  12. Sumawinata IW, Bernadeta Leksana B, Sutamihardja A, Purnomo Subianto B, Sekartuti Fryauff DJ, Baird JK, , 2003. Very high risk of therapeutic failure with chloroquine for uncomplicated Plasmodium falciparum and P. vivax malaria in Indonesian Papua. Am J Trop Med Hyg 68: 416420. [Google Scholar]
  13. Baird JK, 2002. Chloroquine for the treatment of uncomplicated malaria in Guyana. Ann Trop Med Parasitol 96: 339348. [Google Scholar]
  14. Villalobos-Salcedo JM, Tada MS, Kimura E, Menezes MJ, Pereira-da-Silva LH, , 2000. In-vivo sensitivity of Plasmodium vivax isolates from Rond nia (western Amazon region, Brazil) to regimens including chloroquine and primaquine. Ann Trop Med Parasitol 94: 749758. [Google Scholar]
  15. Machado RL, de Figuereido Filho AF, Calvosa VS, Figueredo MC, Nascimento JM, Povoa MM, , 2003. Correlation between Plasmodium vivax variants in Belem, Para state, Brazil and symptoms and clearance of parasitaemia. Braz J Infect Dis 7: 175177. [Google Scholar]
  16. Alecrim M das G, Alecrim W, Macedo V, , 1999. Plasmodium vivax resistance to chloroquine (R2) and mefloquine (R3) in Brazilian Amazon region. Rev Soc Bras Med Trop 32: 6768. [Google Scholar]
  17. Ruebush TK, 2nd 2003. Chloroquine-resistant Plasmodium vivax malaria in Peru. Am J Trop Med Hyg 69: 548552. [Google Scholar]
  18. Añez A, Moscoso M, Laguna Á, Garnica C, Melgar V, Cuba M, Gutierrez S, Ascaso C, , 2015. Resistance of infection by Plasmodium vivax to chloroquine in Bolivia. Malar J 14: 261. [Google Scholar]
  19. Marques MM, 2014. Plasmodium vivax chloroquine resistance and anemia in the western Brazilian Amazon. Antimicrob Agents Chemother 58: 342347. [Google Scholar]
  20. Faway E, Musset L, Pelleau S, Volney B, Casteras J, Caro V, Menard D, Briolant S, Legrand E, , 2016. Plasmodium vivax multidrug resistance-1 gene polymorphism in French Guiana. Malar J 15: 540. [Google Scholar]
  21. Melo GC, 2014. Expression levels of pvcrt-o and pvmdr-1 are associated with chloroquine resistance and severe Plasmodium vivax malaria in patients of the Brazilian Amazon. PLoS One 9: e105922. [Google Scholar]
  22. Ríos A, Álvarez G, Blair S, , 2013. Diez años de eficacia terapéutica de la cloroquina en malaria no complicada por Plasmodium vivax, Turbo, Antioquia, años 2002 y 2011. Biomédica 33: 429438. [Google Scholar]
  23. Castillo CM, Osorio LE, Palma GI, , 2002. Assessment of therapeutic response of Plasmodium vivax and Plasmodium falciparum to chloroquine in a malaria transmission free area in Colombia. Mem Inst Oswaldo Cruz 97: 559562. [Google Scholar]
  24. Pérez M, Cortés L, Guerra A, Knudson A, Usta C, Nicholls R, , 2008. Eficacia de la combinación amodiaquina más sulfadoxina pirimetamina y de la cloroquina para el tratamiento del paludismo en Córdoba, Colombia, 2006. Biomédica 28: 148159. [Google Scholar]
  25. Carmona-Fonseca J, Uscátegui R, Correa A, , 2008. Malaria vivax en niños: aspectos clínicos y respuesta a la cloroquina. Colomb Med 39: 364377. [Google Scholar]
  26. Blair S, Tobon A, Echeverri M, Alvarez G, Carmona J, , 2002. Adecuada respuesta clínica y parasitológica de Plasmodium vivax a la cloroquina en Colombia (Turbo, Antioquia), 2001. Infectio 6: 2126. [Google Scholar]
  27. Soto J, Toledo J, Gutierrez P, Luzz M, Llinas N, Cedeño N, Dunne M, Berman J, , 2001. Plasmodium vivax clinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 65: 9093. [Google Scholar]
  28. Fernández D, Segura C, Arboleda M, Garavito G, Blair S, Pabón A, , 2014. In vitro susceptibility of Plasmodium vivax to antimalarials in Colombia. Antimicrob Agents Chemother 58: 63546359. [Google Scholar]
  29. Ganguly S, Saha P, Guha SK, Das S, Bera DK, Biswas A, Kundu PK, Saha B, Ray K, Maji AK, , 2013. In vivo therapeutic efficacy of chloroquine alone or in combination with primaquine against vivax malaria in Kolkata, West Bengal, India, and polymorphism in pvmdr1 and pvcrt-o genes. Antimicrob Agents Chemother 57: 12461251. [Google Scholar]
  30. Abreha T, , 2017. Comparison of artemether-lumefantrine and chloroquine with and without primaquine for the treatment of Plasmodium vivax infection in Ethiopia: a randomized controlled trial. PLoS Med 14: e1002299. [Google Scholar]
  31. Saravu K, Kumar R, Ashok H, Kundapura P, Kamath V, Kamath A, Mukhopadhyay C, , 2016. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from primary care centres in southwestern India. PLoS One 11: e0157666. [Google Scholar]
  32. Cheoymang A, Ruenweerayut R, Muhamad P, Rungsihirunrat K, Na-Bangchang K, , 2015. Patients’ adherence and clinical effectiveness of a 14-day course of primaquine when given with a 3-day chloroquine in patients with Plasmodium vivax at the Thai-Myanmar border. Acta Trop 152: 151156. [Google Scholar]
  33. Yeshiwondim AK, Tekle AH, Dengela DO, Yohannes AM, Teklehaimanot A, , 2010. Therapeutic efficacy of chloroquine and chloroquine plus primaquine for the treatment of Plasmodium vivax in Ethiopia. Acta Trop 113: 105113. [Google Scholar]
  34. Awab GR, Imwong M, Bancone G, Jeeyapant A, Day NPJ, White NJ, Woodrow CJ, , 2017. Chloroquine-primaquine versus chloroquine alone to treat vivax malaria in Afghanistan: an open randomized superiority trial. Am J Trop Med Hyg 97: 17821787. [Google Scholar]
  35. Rishikesh K, Kamath A, Hande MH, Vidyasagar S, Acharya RV, Acharya V, Belle J, Shastry AB, Saravu K, , 2015. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India. Malar J 14: 310. [Google Scholar]
  36. Carmona-fonseca J, Álvarez G, Blair S, , 2006. Malaria por Plasmodium vivax : curación del ataque agudo con tres dosis diferentes de primaquina y dosis fija de cloroquina. Biomédica 26: 343365. [Google Scholar]
  37. Alvarez G, Piñeros JG, Tobón A, Ríos A, Maestre A, Blair S, Carmona-Fonseca J, , 2006. Efficacy of three chloroquine-primaquine regimens for treatment of Plasmodium vivax malaria in Colombia. Am J Trop Med Hyg 75: 605609. [Google Scholar]
  38. Lacharme L, Carmona-Fonseca J, Tobón-Castaño A, Blair-Trujillo S, Respuesta de P, , 1998. Vivax al esquema terapéutico cloroquina-primaquina en Zaragoza y Turbo, Colombia. Infectio 2: 9094. [Google Scholar]
  39. OPS/RAVREDA, 2003. Red Amazonica de Vigilancia de la Respuesta a los Antimaláricos. Protocolo Genérico para Estudios in Vivo de Eficacia de los Medicamentos Antimaláricos en las Américas. Available at: http://www1.paho.org/Spanish/AD/DPC/CD/mal-genericPv_CQ_Esp.doc.
  40. Organización Panamericana de la Salud, 2010. Guía Práctica Revisada para Estudios de Eficacia de los Medicamentos Antimaláricos en las Américas. HSD/CD/M/005–10. [Google Scholar]
  41. DANE. Colombia. Proyecciones de Población Municipales Por Area 2005–2020. Available at: https://view.officeapps.live.com/op/view.aspx?src=http://www.dane.gov.co/files/investigaciones/poblacion/proyepobla06_20/ProyeccionMunicipios2005_2020.xls. Accesed, august 25, 2018.
  42. Así Vamos en Salud. 2017. Índice Parasitario Anual de Malaria—Georeferenciado. Available at: http://www.asivamosensalud.org/indicadores/estado-de-salud/indice-parasitario-anual-de-malaria-georeferenciado. Accessed February 21, 2017.
  43. PAHO/WHO, 2016. Report on the Situation of Malaria in the Americas, 2000–2015. Washington, DC: Panamerican Health Organization, World Health Organization. Available at: https://www.paho.org/hq/dmdocuments/2017/2017-cha-report-situation-malaria-amer-00-15.pdf.
  44. Organización Panamericana de la Salud, Organización Mundial de la salud, 2016. Informe Situacion Malaria Colombia 2017. 27. [Google Scholar]
  45. Singh B, Bobogare A, Cox-Singh J, Snounou G, Abdullah MS, Rahman HA, , 1999. A genus-and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies. Am J Trop Med Hyg 60: 687692. [Google Scholar]
  46. Zuluaga-Idárraga L, Yepes-Jiménez N, López-Córdoba C, Blair-Trujillo S, , 2014. Validation of a method for the simultaneous quantification of chloroquine, desethylchloroquine and primaquine in plasma by HPLC-DAD. J Pharm Biomed Anal 95: 200206. [Google Scholar]
  47. USP, 2018. Official Monographs. Chloroquine Phospate. Rockville, MD: United States Pharmacopeia. 891892. [Google Scholar]
  48. WHO 2009. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva, Switzerland: World Health Organization, 90. [Google Scholar]
  49. Commons RJ, 2018. The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis. Lancet Infect Dis 18: 10251034. [Google Scholar]
  50. Baird JK, Leksana B, Masbar S, Fryauff DJ, Sutanihardja MA, Suradi Wignall FS, Hoffman SL, , 1997. Diagnosis of resistance to chloroquine by Plasmodium vivax: timing of recurrence and whole blood chloroquine levels. Am J Trop Med Hyg 56: 621626. [Google Scholar]
  51. Ketema T, Bacha K, Birhanu T, Petros B, , 2009. Chloroquine-resistant Plasmodium vivax malaria in Serbo town, Jimma zone, south-west Ethiopia. Malar J 8: 177. [Google Scholar]
  52. Teka H, Petros B, Yamuah L, Tesfaye G, Elhassan I, Muchohi S, Kokwaro G, Aseffa A, Engers H, , 2008. Chloroquine-resistant Plasmodium vivax malaria in Debre Zeit, Ethiopia. Malar J 7: 220. [Google Scholar]
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  • Received : 09 Aug 2018
  • Accepted : 31 Aug 2018
  • Published online : 19 Nov 2018

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