Field Evaluation in Kenya of a 48-Hour in Vitro Test for Plasmodium falciparum Sensitivity to Chloroquine

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  • Clinical Research Centre, Kenya Medical Research Institute, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Public Health Service, U.S. Department of Health and Human Services, Division of Vector-Borne Diseases, Kenya Ministry of Health, and U.S. Army Medical Research Unit—Kenya, Nairobi, Kenya

A 48-hour in vitro test for determining the chloroquine sensitivity of Plasmodium falciparum isolates was evaluated in Kisumu and Malindi, Kenya. P. falciparum isolates from 14 children, aged 5 to 13 years, were studied. In vivo and 48-hour in vitro tests were done on all 14. Successful Rieckmann macro and micro in vitro tests for chloroquine sensitivity were completed in nine isolates each. All 14 infections cleared within 3 days of beginning chloroquine treatment, and none recrudesced during a 7-day (8 patients) or 28-day (6 patients) follow-up period. The three in vitro tests gave comparable results. Although all isolates tested were chloroquine sensitive in vitro, different response patterns were observed. In the 48-hour test, 10 isolates were inhibited at chloroquine concentration ≤0.03 nmol/ml medium. These isolates were inhibited by ≤0.5 nmol of chloroquine per ml blood in the Rieckmann macro test and by 2–6 pmol/well in the micro test. The other four isolates had response patterns intermediate between those of previously reported sensitive and resistant strains. Complete inhibition did not occur until chloroquine concentrations of ⩾0.03 nmol/ml medium in the 48-hour test, ⩾0.5 nmol/ml blood in the macro test, and 6 pmol/well in the micro test. The results demonstrate that the 48-hour test is a useful addition to existing in vivo and in vitro methods for determining the chloroquine sensitivity of P. falciparum in the field.