THERAPEUTIC EFFICACY OF QUININE PLUS SULFADOXINE-PYREMETHAMINE FOR THE TREATMENT OF UNCOMPLICATED FALCIPARUM MALARIA IN BANGLADESH

KAMALA THRIEMER International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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RASHIDUL HAQUE International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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YUKIKO WAGATSUMA International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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MOHAMMED ABDUS SALAM International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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SELIM AKTHER International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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BERNHARD ATTLMAYR International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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MARK FUKUDA International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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KURT SCHAECHER International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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R. SCOTT MILLER International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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HARALD NOEDL International Centre for Diarrhoeal Disease Research, Bangladesh, Bangladesh (ICDDR,B); Centre for Health and Population Research, Dhaka, Bangladesh; Department of Specific Prophylaxes and Tropical Medicine, Medical University of Vienna, Vienna, Austria; BRAC, Dhaka, Bangladesh; USAMC-AFRIMS, Department of Immunology and Medicine, Bangkok, Thailand

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In terms of drug resistance Bangladesh acts as an important gateway to the Indian Subcontinent. However, little is known about the current status of drug resistance in this country. The aim of this study was therefore to determine the therapeutic efficacy as well as in vitro drug sensitivity of quinine for 3 days plus a single dose of sulfadoxine/pyrimethamine (Q3F), an affordable alternative to the previously used chloroquine, for the treatment of uncomplicated falciparum malaria. Sixty-three patients were enrolled in the study; the overall cure rate in a 42-day follow-up after PCR adjustment was 87.3% (95% CI: 77.6–94.1). One patient was classified as early treatment failure (1.7%, 95% CI: 0.0–8.9%); 6 patients (10%; 95% CI: 3.8–20.5%) had late treatment failures within a median time of 27 days. HRP2 in vitro drug sensitivity tests were performed on all samples. Significantly higher (P = 0.008) in vitro IC50s for pyrimethamine in treatment failures reflect the somewhat compromised drug sensitivity to this drug. These data suggest that the combination of 3 days of quinine with a single dose of sulfadoxine/pyrimethamine is an interesting and affordable alternative as long as or whenever ACT is not available.

Author Notes

Reprint requests: Harald Noedl, Department of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Kinderspital-gasse 15, A-1090 Vienna, Austria. Telephone: 43-1-4277-64882, Fax: 43-1-4277-64889, E-mail: harald.noedl@meduniwien.ac.at.
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