Assessing the Efficacy of Chloroquine in the Treatment of Plasmodium Vivax Malaria in Debre Zeit, Ethiopia
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Date
2007-10-05
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Addis Ababa University
Abstract
Chloroquine (CQ) is the first line drug for treatment of P. vivax malaria. However, drug resistance has compromised its use. In Ethiopia, there have been few reports of treatment failure of CQ in treating P. vivax malaria. Therefore, this study aimed to assess the emergence of chloroquine resistance to P. vivax malaria in Debre Zeit, Ethiopia. For this purpose, an in vivo drug efficacy study was conducted in Debre Zeit from June-August, 2006. Eighty-seven patients with microscopically confirmed P. vivax malaria, aged between 8 months to 52 years, were recruited and treated under supervision with chloroquine 25 mg/kg over three days. On enrollment, 39.8% had documented fever and 60.2% had a history of fever. Their geometric mean parasite density was 7,045 parasites/μl. Out of the 87 patients recruited for the study, one was lost to follow-up and three were excluded due to P. falciparum infection during follow-up. A total of 83 (95%) of the study participants completed the 28 days of follow-up. Among these, four patients had recurrent parasitemia on Day 28 showing treatment failure. The blood chloroquine level of the four patients with recurrent parasitemia was determined using high performance liquid chromatography (HPLC). It was 524.6, 672.1, 868.6 and 1164.0ηg/ml, all above the minimal effective concentration (MEC), 100ηg/ml. Parasites from patients with recurrent parasitemia were genotyped using PCR-RFLP to distinguish the parasite strains at Day0 and Day28. Amplification of Day 0 and Day 28 samples was possible for only one patient, which revealed presence of mixed strains of parasite population, which is an indication of parasite diversity. Based on the results from the determination of CQ-DCQ in patients with recurrent parasitemia, it was concluded that clinically resistant parasites are present in Debre Zeit. To better understand the extent of P. vivax resistance to CQ in Ethiopia a multi-center study is recommended.
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Chloroquine Resistance, Debre Zeit, Ethiopia, HPLC, Plasmodium Vivax, PCR-RFLP