Response of Falciparum Malaria to Different Antimalarials in Myanmar

Bull World Health Organ. 1999;77(3):244-9.

Abstract

The purpose of the study was to ascertain the therapeutic efficacy of different treatments for uncomplicated falciparum malaria in the hospitals in Sagaing, northern and eastern Shan, to facilitate updating the existing national antimalarial drug policy. The proposed 14-day trial for monitoring the efficacy of treatments of uncomplicated falciparum malaria is an efficient method for identifying treatment failure patterns at the intermediate level (township hospital) in the Union of Myanmar. Minimal clinical and parasitological data for days 0-14 were required to classify treatment failure and success. Clinical and parasitiological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine is five times more likely to be effective than chloroquine and sulfadoxine pyrimethamine (S-P), whereas chloroquine and S-P treatments have nearly identical failure patterns. The alarming frequency of clinical and parasitological failure (failure rate > 50%) following chloroquine treatment was reported in Sagaing and following S-P treatment in Sagaing and eastern Shan.

PIP: Malaria is a major health problem in Myanmar, a country in which the resistance of Plasmodium falciparum to antimalarial drugs frustrates malaria control efforts and impedes success. Chloroquine and sulfadoxine-pyrimethamine (SP) resistance at various levels is now common throughout the country, while mefloquine resistance currently remains limited to the Thai-Myanmar border. Findings are presented from an assessment of the therapeutic efficacy of treating uncomplicated falciparum malaria in hospitals in Sagaing Division and Shan State with a view to updating the existing national antimalarial drug policy. 118 patients aged 1-58 years with acute uncomplicated falciparum malaria were recruited into the study conducted in the township hospitals of Katha, Hsipaw, and Tachileik, an overall area characterized by endemic and seasonal forest-related malaria. The most prevalent parasite species is P. falciparum. Patients were randomly assigned to receive either chloroquine, SP, or mefloquine in 14-day trials. Minimal clinical and parasitological data for days 0-14 were needed to classify treatment failure and success. Clinical and parasitological responses on day 3 and days 4-14 were used as clear examples of early and late treatment failure, respectively. Mefloquine was found to be 5 times more likely to be effective than chloroquine and SP, while chloroquine and SP treatments have almost identical failure patterns. A higher than 50% failure rate following chloroquine treatment was reported in Sagaing and following SP treatment in Sagaing and eastern Shan.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antimalarials / therapeutic use*
  • Child
  • Child, Preschool
  • Chloroquine / therapeutic use*
  • Drug Therapy, Combination
  • Humans
  • Infant
  • Malaria, Falciparum / drug therapy*
  • Mefloquine / therapeutic use*
  • Myanmar
  • Pyrimethamine / therapeutic use*
  • Sulfadoxine / therapeutic use*

Substances

  • Antimalarials
  • Sulfadoxine
  • Chloroquine
  • Mefloquine
  • Pyrimethamine