Chloroquine/doxycycline combination versus chloroquine alone, and doxycycline alone for the treatment of Plasmodium falciparum and Plasmodium vivax malaria in northeastern Irian Jaya, Indonesia.

Abstract

Abstract. Combination therapy is one method of overcoming the global challenge of drug-resistant Plasmodium falciparum malaria. We conducted a hospital-based 28-day in vivo test comparing chloroquine/doxycycline to chloroquine or doxycycline alone for treating P. falciparum and Plasmodium vivax malaria in Irian Jaya, Indonesia. Eighty-nine patients with uncomplicated falciparum malaria were randomized to standard dose chloroquine (n ϭ 30), doxycycline (100 mg every 12 hours [7 days], n ϭ 20), or chloroquine with doxycycline (n ϭ 39); corresponding numbers for vivax malaria (n ϭ 63) were 23, 16, 24. Endpoints were parasite sensitivity (S) or resistance (RI/RII/ RIII Chloroquine/doxycycline was effective against P. falciparum but only modestly effective against P. vivax. These findings support the use of chloroquine/doxycycline as an inexpensive alternative to mefloquine for treating chloroquine-resistant P. falciparum but not chloroquine-resistant P. vivax in this setting.

Chloroquine Resistance inPlasmodium vivax

“…Among 88 subjects treated up to 1995, 41% had a response consistent with resistance (8,81). Among 282 subjects evaluated since then, 39% were infected with resistant isolates (9,11,48,52,102,106). However, all 38 subjects evaluated on a small, isolated island in Papua had infections with sensitive organisms (52).…”

“…Ohrt et al (85) demonstrated the complete efficacy of mefloquine for prophylaxis against the CRPV strain known to occur in northeastern Indonesian New Guinea. However, they also found that daily doxycycline had complete efficacy against CRPV, and Taylor et al (106) showed doxycycline monotherapy to have only 33% efficacy against CRPV. Clinical trials of mefloquine against CRPV are needed.…”

Neglect of Plasmodium vivax malaria

“…Effective therapies for chloroquine-resistant P. vivax A few reports describe the efficacy of approved drugs for the treatment of P. vivax [50][51][52][53], and some reports describe treatments for CQ-resistant P. vivax [54][55][56]. Mefloquine (MQ) combined with PQ was effective in Papua, Indonesia (98% efficacy) [47], and CQ combined with PQ was much more effective than CQ alone [47,54].…”

Short report: therapeutic efficacy of chloroquine combined with primaquine against Plasmodium falciparum in northeastern Papua, Indonesia.

“…These findings also corroborate the very high risk of therapeutic failure with chloroquine monotherapy against P. falciparum acquired in northeastern Papua, Indonesia. [7][8][9] …”