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Am. J. Trop. Med. Hyg., 77(5), 2007, pp. 947-954
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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Low Efficacy of Amodiaquine or Chloroquine Plus Sulfadoxine-Pyrimethamine against Plasmodium falciparum and P. vivax Malaria in Papua New Guinea

Jutta Marfurt, Ivo Müeller, Albert Sie, Peter Maku, Mary Goroti, John C. Reeder, Hans-Peter Beck, AND Blaise Genton*
Department of Medical Parasitology and Infection Biology, Swiss Tropical Institute, Basel, Switzerland; Papua New Guinea Institute of Medical Research, Goroka, Maprik, and Madang, Papua New Guinea

Because of increasing resistance to 4-aminoquinolines in Papua New Guinea, combination therapy of amodiaquine (AQ) or chloroquine (CQ) plus sulfadoxine-pyrimethamine (SP) was introduced as first-line treatment against uncomplicated malaria in 2000. The purpose of this study was to monitor in vivo efficacy of the current standard combination therapy against Plasmodium falciparum and P. vivax malaria. Studies were conducted between 2003 and 2005 in the Simbu, East Sepik, and Madang Provinces in Papaua New Guinea according to the revised protocol of the World Health Organization (WHO) for assessment of antimalarial drug efficacy. Children between six months and seven years of age with clinically overt and parasitologically confirmed P. falciparum or P. vivax malaria were treated according to the new policy guidelines (i.e., AQ plus SP given to patients weighing < 14 kg and CQ plus SP given to patients weighing < 14 kg). Children were monitored up to day 28 and classified according to clinical and parasitological outcome as adequate clinical and parasitological response (ACPR), early treatment failure (ETF), late clinical failure (LCF), or late parasitological failure (LPF). For P. falciparum malaria, polymerase chain reaction (PCR)–corrected treatment failure rates up to day 28 ranged between 10.3% and 28.8% for AQ plus SP and between 5.6% and 28.6% for CQ plus SP, depending on the region and the year of assessment. Overall treatment failure rate with AQ or CQ plus SP for P. vivax malaria was 12%. Our results suggest that the current first-line treatment in Papua New Guinea is not sufficiently effective. According to the new WHO guidelines for the treatment of malaria, a rate of parasitological resistance greater than 10% in the two dominant malaria species in the country justifies a change in treatment policy.

Received July 16, 2006. Accepted for publication June 23, 2007.

Acknowledgments: We thank the study participants and their parents or legal guardians who made themselves available for these studies; field and laboratory staff at the Papua New Guinea Institute of Medical Research branches in Goroka, Maprik, and Madang, notably Rex Ivivi, Marc Gomobi, Olive Oa, Merolyn Uranoli, Donald Abari, Moses Lagog, Moses Baisor, Rebecca Samen, and Nandao Tarongka, for their assistance with patient recruitment and microscopical analysis; Gerard J. Casey for supervision of field projects at the Madang site; and Ingrid Felger and Dania Müller (Swiss Tropical Institute) for technical support and advice during the course of this study.

Financial support: This study was supported by the Swiss National Science Foundation (grant no: 3100-AO-103968) and the World Health Organization Western Pacific Regional Office.

* Address correspondence to Blaise Genton, Ifakara Health Research & Development Centre, P.O. Box 78373, Dar es Salaam, Tanzania. E-mail: Blaise.Genton{at}unibas.ch

Authors’ addresses: Jutta Marfurt, Federal Department of Home Affairs DHA, Swiss Federal Office of Public Health SFOPH, Division of Communicable Diseases, Section of Early Warning and Epidemiology, Schwarztorstrasse 96, CH-3003 Bern, Switzerland. Ivo Müeller and Albert Sie, Papua New Guinea Institute of Medical Research, Goroka, PO Box 60, EHP 441, Papua New Guinea. Peter Maku, Papua New Guinea Institute of Medical Research, Maprik, PO Box 400, ESP 533, Papua New Guinea. Mary Goroti, Papua New Guinea Institute of Medical Research, Madang, PO Box 378, MP 511, Papua New Guinea. John C. Reeder, International Health Research Strategy, Burnet Institute for Medical Research and Public Health, PO Box 2284, Melbourne, Victoria 2001, Australia. Blaise Genton, If-akara Health Research and Development Centre, PO Box 78373, Dar es Salaam, Tanzania.

Reprint requests: Blaise Genton, Ifakara Health Research and Development Centre, PO Box 78373, Dar es Salaam, Tanzania, Telephone: 255-222-774-756, Fax: 255-222-771-714, E-mail: Blaise.Genton{at}unibas.ch.






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