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Antimicrobial Agents and Chemotherapy, June 2000, p. 1680-1685, Vol. 44, No. 6
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Therapeutic Responses to Different Antimalarial Drugs in Vivax Malaria

Sasithon Pukrittayakamee,1 Arun Chantra,1 Julie A. Simpson,1,2 Sirivan Vanijanonta,1 Ralf Clemens,1,3 Sornchai Looareesuwan,1 and Nicholas J. White1,2,*

Department of Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand1; Center for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, United Kingdom2; and SmithKline Beecham, Rixensart, Belgium3

Received 28 December 1999/Returned for modification 7 February 2000/Accepted 6 March 2000

The therapeutic responses to the eight most widely used antimalarial drugs were assessed in 207 adult patients with Plasmodium vivax malaria. This parasite does not cause marked sequestration, so parasite clearance can be used as a direct measure of antimalarial activity. The activities of these drugs in descending order were artesunate, artemether, chloroquine, mefloquine, quinine, halofantrine, primaquine, and pyrimethamine-sulfadoxine (PS). Therapeutic responses to PS were poor; parasitemias did not clear in 5 of the 12 PS-treated patients, whereas all the other patients made an initial recovery. Of 166 patients monitored for >= 28 days, 35% had reappearance of vivax malaria 11 to 65 days later and 7% developed falciparum malaria 5 to 21 days after the start of treatment. There were no significant differences in the times taken for vivax malaria reappearance among the different groups except for those given mefloquine and chloroquine, in which all vivax malaria reappearances developed >28 days after treatment, suggesting suppression of the first relapse by these slowly eliminated drugs. There was no evidence of chloroquine resistance. The antimalarial drugs vary considerably in their intrinsic activities and stage specificities of action.

* Corresponding author. Mailing address: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd., Bangkok 10400, Thailand. Phone: 66-2-246-0832. Fax: 66-2-246-7795. E-mail: fnnjw{at}diamond.mahidol.ac.th.

Antimicrobial Agents and Chemotherapy, June 2000, p. 1680-1685, Vol. 44, No. 6
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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