Chloroquine-resistant Plasmodium vivax malaria in Debre Zeit, Ethiopia

Teka, Hiwot; Petros, Beyene; Yamuah, Lawrence; Tesfaye, Gezahegn; Elhassan, Ibrahim M.; Muchohi, Simon N.; Kokwaro, Gilbert; Aseffa, Abraham; Engers, Howard

doi:10.1186/1475-2875-7-220

Cited by 92 publications

(91 citation statements)

References 29 publications

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“…Although P. vivax resistance to CQ has been reported from several parts of the world, mainly Asia and South America, 12, 13 a report on confirmed P. vivax resistance from Ethiopia is quite recent, and the findings from this study further confirm CQ resistance reported in two other recent studies. 14,15 It is not known if the recurrent parasitemia cases detected in this study were caused by relapse, recrudescence, or reinfection. Based on the Indonesian experience, it has been suggested that failures after CQ therapy until day 16 are almost always caused by recrudescence, whereas failure between day 17 and 28 may be caused by recrudescence, reinfection, or relapse.…”

Section: Discussionmentioning

confidence: 88%

Confirmed Vivax Resistance to Chloroquine and Effectiveness of Artemether-Lumefantrine for the Treatment of Vivax Malaria in Ethiopia

Yohannes

Teklehaimanot²,

Bergqvist³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Chloroquine (CQ) is still the drug of choice for the treatment of vivax malaria in Ethiopia, whereas artemether-lumefantrine (AL) is for falciparum malaria. In this setting, clinical malaria cases are treated with AL. This necessitated the need to assess the effectiveness of AL for the treatment of Plasmodium vivax with CQ as a comparator. A total of 57 (80.3%) and 75 (85.2%) cases treated with CQ or AL, respectively, completed the study in an outpatient setting. At the end of the follow-up period of 28 days, a cumulative incidence of treatment failure of 7.5% (95% confidence interval [CI] = 2.9–18.9%) for CQ and 19% (95% CI = 11–31.6%) for AL was detected. CQ resistance was confirmed in three of five CQ treatment failures cases. The effectiveness of AL seems lower than CQ; however, the findings were not conclusive, because the AL evening doses were not supervised.

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Section: Discussionmentioning

confidence: 88%

Confirmed Vivax Resistance to Chloroquine and Effectiveness of Artemether-Lumefantrine for the Treatment of Vivax Malaria in Ethiopia

Yohannes

Teklehaimanot²,

Bergqvist³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…The emergence of resistance to CQ and the failing efficacy of PQ regimens in preventing relapses have raised great concerns in the control of P. vivax malaria. 9,10 Clinical CQ-resistant (CQR) P. vivax was first reported from Papua New Guinea in 1989, 11,12 followed by multiple reports from Indonesia, [13][14][15] Myanmar, 16,17 India, 18,19 Guyana, 20 Brazil, 21,22 Colombia, 23 and more recently in Ethiopia 24 and South Korea. 25 Continued surveillance of P. vivax drug resistance may detect CQR P. vivax parasites in most of its geographic range.…”

Section: Introductionmentioning

confidence: 99%

In vitro Anti-Malarial Drug Susceptibility of Temperate Plasmodium vivax from Central China

Lu¹,

Gao²,

Chotivanich³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. In the face of recent increase of Plasmodium vivax malaria in central China, we conducted a study to evaluate in vitro susceptibility of temperate-zone P. vivax parasites to antimalarial drugs. During 2005During -2006, in vitro drug susceptibility was measured for 42 clinical P. vivax isolates by using a schizont maturation inhibition technique. Geometric means of 50% inhibitory concentrations (IC 50 s) and 95% confidence intervals (CIs) were 10.87 (4.50-26.26) ng/mL for chloroquine, 4.21 (1.88-9.42-8) ng/mL for mefloquine, 11.82 (6.20-22.56) ng/mL for quinine, 0.13 (0.09-0.20) ng/mL for artesunate, 18.32 (8.08-41.50) ng/mL for pyrimethamine, and 17.73 (10.29-30.57) ng/mL for piperaquine. The IC 50 for chloroquine was lower than those obtained from isolates from Thailand and South Korea, suggesting that chloroquine remained effective against P. vivax malaria in central China. The results further indicated that temperate-zone P. vivax isolates from China were more susceptible to chloroquine, quinine, and mefloquine than isolates from Thailand.

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“…An updated search of available literature identified 231 titles, of which two RCTs) [18,19], 15 one-arm in vivo drug efficacy studies [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], and four prospective observational studies [35][36][37][38] were deemed eligible included in this analysis came from individual treatment programmes across Ethiopia and reported treatment outcomes for a range of 69 [35] to 487 patients [26]. One unpublished Master's thesis dissertation [36] was included and the rest were published in scientific journals [18-35, 37, 38].…”

Section: Resultsmentioning

confidence: 99%

“…It revealed significant differences between the lowquality studies (86.1%, 95% CI 69.7-102.6, p = <0.001, I 2 = 99.35%) [20,26,28,30,32,33,35,38] and high quality studies (96.9%, 95% CI 95.4-98.3, p < 0.001; I 2 = 81.7%) [18, 19, 21-25, 27, 29, 31, 36, 37]. Publication bias was also assessed using a funnel plot (Additional file 4).…”

Section: Quality Assessment and Sensitivity Analysismentioning

confidence: 94%

“…Seventeen interventional studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] were assessed using the modified Jadad scale [14] while the remaining four studies [35][36][37][38] were assessed with the STROBE statement [15]. Eleven interventional and two observational studies were judged to have high quality (Additional file 3).…”

Section: Quality Assessment and Sensitivity Analysismentioning

confidence: 99%

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Antimalarial Treatment Outcomes In Ethiopia: A Systematic Review And Meta-Analysis

et al. 2017

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Background: Ethiopia is among countries with a high malaria burden. There are several studies that assessed the efficacy of anti-malarial agents in the country and this systematic review and meta-analysis was performed to obtain stronger evidence on treatment outcomes of malaria from the existing literature in Ethiopia. Methods:A systematic literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on studies from Pubmed, Google Scholar, and ScienceDirect databases to identify published and unpublished literature. Comprehensive meta-analysis software was used to perform all meta-analyses. The Cochrane Q and the I 2 were used to evaluate heterogeneity of studies. Random effects model was used to combine studies showing heterogeneity of Cochrane Q p < 0.10 and I 2 > 50.Results: Twenty-one studies were included in the final analysis with a total number of 3123 study participants. Treatment outcomes were assessed clinically and parasitologically using World Health Organization guidelines. Adequate clinical and parasitological response was used to assess treatment success at the 28th day. Overall, a significant high treatment success of 92.9% (95% CI 89.1-96.6), p < 0.001, I 2 = 98.39% was noticed. However, treatment success was higher in falciparum malaria patients treated with artemether-lumefantrine than chloroquine for Plasmodium vivax patients [98.1% (97.0-99.2), p < 0.001, I 2 = 72.55 vs 94.7% (92.6-96.2), p < 0.001, I 2 = 53.62%]. Seven studies reported the adverse drug reactions to anti-malarial treatment; of 822 participants, 344 of them were exposed to adverse drug reactions with a pooled event rate of 39.8% (14.1-65.5), p = 0.002. Conclusions:On the basis of this review, anti-malarial treatment success was high (92.9%) and standard regimens showed good efficacy against Plasmodium falciparum (98.1%) and P. vivax (94.7%) infections in Ethiopia, but associated with high rates of adverse drug reactions (ADRs). However, these ADRs were not serious enough to discontinue anti-malarial treatment. The results of this study suggest that the current anti-malarial medications are effective and safe; however, greater priority should be placed on the discovery of new anti-malarial drugs to achieve successful outcomes as resistance seems inevitable since cases of anti-malarial drug resistance have been reported from other areas of the world.

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Chloroquine-resistant Plasmodium vivax malaria in Debre Zeit, Ethiopia

Cited by 92 publications

References 29 publications

Confirmed Vivax Resistance to Chloroquine and Effectiveness of Artemether-Lumefantrine for the Treatment of Vivax Malaria in Ethiopia

Confirmed Vivax Resistance to Chloroquine and Effectiveness of Artemether-Lumefantrine for the Treatment of Vivax Malaria in Ethiopia

In vitro Anti-Malarial Drug Susceptibility of Temperate Plasmodium vivax from Central China

Antimalarial Treatment Outcomes In Ethiopia: A Systematic Review And Meta-Analysis

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