Clinical efficacy of chloroquine versus artemether-lumefantrine for Plasmodium vivax treatment in Thailand

Chloroquine remains the drug of choice for the treatment of vivax malaria in Thailand. Mixed infections of falciparum and vivax malaria are also common in South-East Asia. Laboratory confirmation of malaria species is not generally available. This study aimed to find alternative regimens for treating both malaria species by using falciparum antimalarial drugs. From June 2004 to May 2005, 98 patients with Plasmodium vivax were randomly treated with either artemether-lumefantrine (n = 47) or chloroquine (n = 51). Both treatments were followed by 15 mg of primaquine over 14 days. Adverse events and clinical and parasitological outcomes were recorded and revealed similar in both groups. The cure rate was 97.4% for the artemether-lumefantrine treated group and 100% for the chloroquine treated group. We concluded that the combination of artemether-lumefantrine and primaquine was well tolerated, as effective as chloroquine and primaquine, and can be an alternative regimen for treatment of vivax malaria especially in the event that a mixed infection of falciparum and vivax malaria could not be ruled out.

A database of antimalarial drug resistance

A large investment is required to develop; license and deploy a new antimalarial drug. Too often; that investment has been rapidly devalued by the selection of parasite populations resistant to the drug action. To understand the mechanisms of selection; we need detailed information on the patterns of drug use in a variety of environments; and the geographic and temporal patterns of resistance that result. Currently; there is no publically accessible central database that contains information on the levels of resistance to antimalaria drugs. This paper outlines the resources that are available; and the steps that might be taken to create a dynamic; open access database that would include current and historical data on clinical efficacy; in vitro responses and molecular markers related to drug resistance in P. falciparum and P. vivax. The goal is to include historical and current data on resistance to commonly used drugs like chloroquine and sulfadoxine-pyrimethamine; and on the many combinations that are now being tested in different settings. The database will be accessible to all on the Web. The information in such a database will inform optimal utilization of current drugs and sustain the longest possible therapeutic life of newly introduced drugs and combinations. The database will protect the valuable investment represented by the development and deployment of novel therapies for malaria