Treatment of uncomplicated in vitro chloroquine resistant falciparum malaria with artemether in Irian Jaya

Abstract

Chloroquine resistant malaria is a serious in Indonesia especially in Irian Jaya. Artemether is a new antimalarial drug reported to be very effective and safe in clinical studies. This drug is no, yet available in Indonesia. To obtain an alternative antimalarial ugfor the treatment of chloroqume res,stant falciparum malaria cases, a trial of artemether treatment for uncomplicated falciparum. was sonduted at FreePort Hospital. Tembagapura, Irian Jaya. Indonesia in April-November 1994. The objective of the study was to assess the efficacy and tolerance of artemether. Sixty-six out of 307 uncomplicated falciparum malaria cases were eligible for in vitro sensitivity tests. Only 44 of the 54 uncomplicsted in vitri chloroquine resistant falcipaum malaria patients could be recuited untilrl. They were treated orally with 1.6 mg/kg b.i.d on day 0 and followed by a daily dose on day 1-4. Alt patients were hospitalized until clinically and parasitologically cured. The most frequent symptoms and signs of these patients were headache (82%) pallor (55 day 14% nausea (55%), fever (41%) and chills (39%). The parasite clearance rate of artemether was 100% (38/38. 38/38. 31/31) on day 7 day,4. and day 21. However this was reduced to 90.3% (28/31) on day 28 because of, he presence of 3 (9.7%) recrudescence cases The mean fever clearance times and parasite clearance times were as follow:9±10 hours and 31 ± 10 hours (day 7 day 14) 8 ± 10 hours and 30 ±9 hours (day 21). 8 ±,0 hours and 29 ± 9 hours (day 28) respectively. A bdominal pain (7 9%) and diarrhoea (5.3%) were noted as the side effects of artemether, both mild and self-limiting. Artemether is effective and well,tolerated for the treatment of uncomplicated in vitro chloroqume resistant falciparum malaria until day 21 in Timika Irian Jaya Modification fo artemether dosage and schedule or combination of artemether with other antimalarial drugs should he studied to achieve a radical cure.