Evaluation of artemisinin-based combination therapy (ACT) to uncomplicated falciparum malaria patients in Purworejo District, Central Java, Indonesia

Abstract

Artemisinin-based Combination Therapy (ACT) to treat uncomplicated Plasmodium falciparum malaria has been applied in Purworejo District, Central Java, Indonesia, since 2004. However evaluation of the two ACT regimens used ie: Artesunate Amodiaquine (AAQ) and Dihydroartemisinin-Piperaquine (DHP) co-administered with Primaquine (PQ) has not been performed. This study aims to evaluate the efficacy and adverse events of AAQ+PQ and DHP+PQ treatment in uncomplicated falciparum malaria in Purworejo. In this descriptive and observational study, 46 Pf infected patients who fullfill the inclusion and exclusion criterias were recruited from December 2010 to August 2011. Standard ACT treatment were given to the patients followed by WHO drug efficacy evaluation for 28 days. The clinical symptoms and adverse events was also evaluated over the course of the treatment. From all recruited subjects, 37 patients received DHP+PQ and 9 patients received AAQ+PQ. On the DHP+PQ treated patient, all subjects were free of asexual and sexual parasites by Day-3 while on AAQ+PQ treated patient, this parasite clearance was achieved faster as early as on D-2 at the latest. On the otherhand, the disappearance of fever was also last longer in DHP+PQ treated patient which in one patient last on D-14, while in AAQ+PQ treated patient, the symptom of fever dissappeared by D-2 at the latest. No Early or Late Treatment Failures were found on either DHP+PQ or AAQ+PQ treatment as well as clinical and parasitological failures. However, the presence of adverse events cause by both drugs should not be ignored to ensure drug compliance. J Med Sci, Volume 48,No. 1, 46 ABSTRAKTerapi malaria dengan Artemisinin-based Combination Therapy (ACT) untuk malaria tanpa komplikasi diterapkan di Kabupaten Purworejo, Jawa, Indonesia, sejak tahun 2004. Namun demikian evaluasi terhadap efektivitas dua regimen ACT yang digunakan yaitu Artesunate Amodiakuin (AAQ) dan Dihydroartemisinin-Piperaquine (DHP) disertai Primakuin (PQ) belum pernah dilakukan. Penelitian ini bertujuan untuk mengevaluasi efikasi dan adverse events AAQ + PQ dan DHP + PQ pada penderita malaria tanpa komplikasi di Purworejo. Penelitian ini merupakan penelitian deskriptif dan observasional. Subjek penelitian adalah pasien yang terinfeksi P. falciparum yang memenuhi kriteria inklusi dan eksklusi, direkrut dari Desember 2010 hingga Agustus 2011. Status resistensi obat, dan adverse events dievaluasi menggunakan cara evaluasi baku WHO selama 28 hari. Dari semua subjek yang direkrut (46), 37 penderita diobati dengan DHP + PQ dan 9 penderita dengan AAQ + PQ. Pada kelompok yang mendapat pengobatan DHP + PQ, semua subyek bebas dari parasit stadium aseksual dan seksual pada hari ke 3, sedangkan kelompok yang mendapatkan pengobatan AAQ + PQ, parasit sudah menghilang dari sirkulasi darah pada hari-2. Semua penderita yang diobati DHP+PQ gejala demam menghilang lebih lama yaitu sampai hari ke 14, sedangkan pada penderita yang diobati dengan AAQ + PQ gejala demam sudah menghilang sejak hari ke 2. Tidak ada keg...

The Effect of Sambiloto and Spirulina Combination on Mucin-1 Protein Expression in Medial Colon of Plasmodium berghei ANKA Infected Mice

“…ACT prevents recurrent parasitemia before day 28, longer the prophylactic effect, reducing symptoms faster than monotherapy and chloroquine. [7][8][9] However, even its in common, ACT treatment can cause side effects, such as nausea, vomiting, stomach pain, and even black urine. 7 As an alternative to malaria treatment, herbal plants have been one of the options.…”

“…[7][8][9] However, even its in common, ACT treatment can cause side effects, such as nausea, vomiting, stomach pain, and even black urine. 7 As an alternative to malaria treatment, herbal plants have been one of the options. One of the potential plants is sambiloto (Andrographis paniculata).…”