Quinine with Tetracycline for the Treatment of Drug-Resistant Falciparum Malaria in Thailand

George Watt Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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Lersan Loesuttivibool Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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G. Dennis Shanks Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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Ellen F. Boudreau Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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Arthur E. Brown Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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Katchrinnee Pavanand Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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H. Kyle Webster Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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Suwit Wechgritaya Armed Forces Research Institute of Medical Science, Royal Thai Army Hospital, Bangkok, Thailand

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DOI:
https://doi.org/10.4269/ajtmh.1992.47.108
Volume/Issue:
Volume 47: Issue 1
Page(s):
108–111
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Reports of deteriorating quinine efficacy prompted us to investigate the ability of quinine-tetracycline to clear parasites and fever from patients with multiple drug-resistant Plasmodium falciparum infections. Past and present treatment results were compared at two study sites along the Thai-Cambodian border. In northeastern Thailand, quinine-tetracycline cleared parasites more quickly in 1990 than in 1987 (mean 3.4 and 4.0 days, respectively; P = 0.006). In southeastern Thailand, there were no significant differences between 1990 (n = 26) and 1981–1983 (n = 42) in the time taken to clear either parasites (median 96 and 93 hr, respectively; P = 0.35) or fever (mean 74 and 66 hr, respectively; P = 0.30). In vitro drug sensitivity testing revealed a two-fold decrease in susceptibility to quinine between 1983 and 1990 in isolates from the southeastern Thai-Cambodian border (mean inhibitory concentration 166 ng/ml and 320 ng/ml, respectively; P < 0.001). We conclude that oral quinine-tetracycline continues to reliably clear parasites and fever from falciparum malaria patients infected in eastern Thailand. Periodic re-evaluations are warranted, however, since the decrease in in vitro susceptibility to quinine may be followed by an in vivo decay in the treatment response.
Copyright:
Copyright © 1992 by The American Society of Tropical Medicine and Hygiene 1992
Published Online:
Jul 1992
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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