Therapeutic efficacy test in malaria falciparum in Antioquia, Colombia

Abstract

Objective: Evaluate the frequency of failure of eight treatments for non-complicated malaria caused by Plasmodium falciparum in patients from Turbo (Urabá region), El Bagre and Zaragoza (Bajo Cauca region), applying the 1998 protocol of the World Health Organization (WHO). Monotherapies using chloroquine (CQ), amodiaquine (AQ), mefloquine (MQ) and sulphadoxinepyrimethamine (SP), and combinations using chloroquine-sulphadoxine-pyrimethamine (CQ-SP), amodiaquine-sulphadoxine-pyrimethamine (AQ-SP), mefloquine-sulphadoxine-pyrimethamine (MQ-SP) and artesunate-sulphadoxine-pyrimethamine (AS-SP), were examined. Methodology:A balanced experimental design with eight groups. Samples were selected based on statistical and epidemiological criteria. Patients were followed for 21 to 28 days, including seven or eight parasitological and clinical evaluations, with an active search for defaulting patients. A nonblinded evaluation of the antimalarial treatment response (early failure, late failure, adequate response) was performed.Results: Initially, the loss of patients to follow-up was higher than 40%, but the immediate active search for the cases and the monetary help for transportation expenses of patients, reduced the loss to 6%. The treatment failure was: CQ 82%, AQ 30%, MQ 4%, SP 24%, CQ-SP 17%, AQ-SP 2%, MQ-S-P 0%, AS-SP 3%.

K13 Propeller Alleles, mdr1 Polymorphism, and Drug Effectiveness at Day 3 after Artemether-Lumefantrine Treatment for Plasmodium falciparum Malaria in Colombia, 2014-2015

“…Although we did not perform a classic therapeutic efficacy study, our findings reflect the AL response of patients under ordinary day-to-day conditions in Colombia. The low D3-positivity rate that we measured is consistent with similarly low estimates (0% to 8.6%) in a systematic review of 11 efficacy studies in South America (3,5,18,27). Overall, our data suggest that a small minority of Colombian parasites survives ART exposure at 72 h and thus could evolve genetic changes that confer decreased susceptibility to LF.…”

“…The treatment for uncomplicated P. falciparum malaria in Colombia was chloroquine (CQ) monotherapy until the early 1980s, when CQ resistance appeared and combinations of CQ or amodiaquine (AQ) with sulfadoxine-pyrimethamine (SP) were used. Based on 44% and 97% CQ failure rates (3,4), the combination of AQ and SP (AQϩSP) officially became the frontline treatment in 1999 and was used throughout Colombia until 2006. At that time, artemether-lumefantrine (AL)-an artemisinin (ART) combination therapy (ACT)-was introduced throughout Colombia except for Antioquia state, where the combination of artesunate and mefloquine (AS-MQ), plus primaquine for P. falciparum gametocyte elimination, was used for 1 year (5).…”

Longitudinal analysis of Plasmodium falciparum genetic variation in Turbo, Colombia: implications for malaria control and elimination

“…A total of 257 P. falciparum blood samples collected on filter paper between 2002 and 2009 from surveillance studies carried out in Turbo (Antioquia department, Colombia) were genotyped: 94 samples were collected between October 2002 and July 2003, 80 from January 2004 to December 2005, 47 between April and October 2007, and 36 between March 2008 and July 2009. All samples came from P. falciparum -positive patients diagnosed by blood smear that gave their consent to participate in therapeutic efficacy studies at their local hospital [ 14 , 18 ]. The samples used were those collected prior treatment [ 14 , 18 ].…”

“…All samples came from P. falciparum -positive patients diagnosed by blood smear that gave their consent to participate in therapeutic efficacy studies at their local hospital [ 14 , 18 ]. The samples used were those collected prior treatment [ 14 , 18 ]. The inclusion criteria for the participants were: (a) patients that were older than 1 year of age with fever that lasted 48 h, (b) the patients were living permanently in the study site, and (c) none had severe malaria or were pregnant.…”

“…breeding sites) into different towns. These local movements are considered important in the maintenance of malaria transmission in Colombia and other similar settings in the Americas [ 1 , 14 ]. Samples were genotyped at several microsatellite loci and analysed using Bayesian coalescent methodologies that have been successfully applied to other human pathogens [ 15 – 17 ].…”