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EFFICACY OF CHLOROQUINE, SULFADOXINE-PYRIMETHAMINE, AND MEFLOQUINE FOR THE TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA ON THE NORTH COAST OF PERU

As part of an effort to assess antimalarial drug resistance in Peru, we carried out 14-day in vivo efficacy trials of chloroquine (CQ; 25 mg/kg) and sulfadoxine-pyrimethamine (SP; 25 mg/kg of the sulfadoxine component) for the treatment of uncomplicated Plasmodium falciparum infections at three sites on the northern coast of Peru. Mefloquine (MQ; 15 mg/kg) also was evaluated at one site. The results from all three sites were similar. Of the 53 patients treated with CQ, 58.5% had RII/RIII responses. No RIII failures were observed among the 112 patients who received SP, but 4.5% and 1.8%, respectively, had RII and RI responses. All 33 patients treated with MQ showed a sensitive response. Early treatment failures were observed in 27.1% of the CQ patients but in no patients receiving SP or MQ. Late treatment failures were seen in 59.3% of the CQ patients and 6.4% of the SP patients but in none of those treated with MQ. Based on these findings and because of concern about the potential for development of resistance if SP were used alone, the National Malaria Control Program is planning a change in malaria treatment policy to SP-artesunate combination therapy for this region of the country.

Received April 20, 2002. Accepted for publication September 23, 2002.

Acknowledgments: We thank the staff of the Zarumilla, Bellavista, and La Arena Health Centers for their assistance with the enrollment, treatment, and follow-up of patients, and Drs. Milton Feijoo, José Leyton, Ana Maria Palacios, and Isabel Najarro, without whose support these studies would not have been possible.

Financial support: This study was supported by the USAID-Government of Peru VIGIA Project, Addressing Threats of Emerging and Re-Emerging Infectious Diseases (Activity 527-0391).

Reprint requests: Trenton K. Ruebush II, Division of Parasitic Diseases (F-22), Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, Telephone: 770-488-3604, Fax: 770-488-4203, E-mail: tkr1{at}cdc.gov

Authors’ addresses: Wilmer Marquiño, César Cabezas, Blanca Pardavé (deceased), Sonia Gutierrez, and Nancy Arrospide, Instituto Nacional de Salud, Capac Yupanqui, 1400, Jesus Maria 11, Lima, Peru. Carlos Carrillo, Departamento de Microbiologia, Universidad Peruana Cayetano Heredia, Honorio Delgado S/N, San Martin de Porres, Lima, Peru. Lawrence Barat, World Bank, 1818 H Street NW, Washington DC 20043. John MacArthur and Trenton K. Ruebush II, Malaria Epidemiology Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341. Fernando E. Oblitas, Manuel Arrunategui, Gino Garavito, and Maritza L. Chafloque, Ministerio de Salud, Avenida Salaverry, Cuadra 8 S/N, Jesús María, Lima, Peru.

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