Saravu Kavitha, Kumar Rishikesh, Ashok Herikudru, Kundapura Premananda, Kamath Veena, Kamath Asha, Mukhopadhyay Chiranjay
Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, India.
District Health Office, Udupi, Karnataka, India.
PLoS One. 2016 Jun 17;11(6):e0157666. doi: 10.1371/journal.pone.0157666. eCollection 2016.
Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India.
Five PHCs were selected within Udupi taluk based on probability proportional to size. In-vivo therapeutic efficacy assessment of CQ (1500 mg over three days) plus PQ (210 mg over 14 days) regimen was carried out in accordance with the World Health Organization's protocol of 28 days follow-up among microscopically diagnosed monoinfection P. vivax cohort.
In total, 161 participants were recruited in the study of which, 155 (96.3%) participants completed till day 28 follow-up, fully complied with the treatment regimen and showed adequate clinical and parasitological response. Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%). Glucose-6-phosphate dehydrogenase deficiency (G6PDd, <30% of normal mean activity) was noted among 5 (3.1%) participants and one of them did develop PQ induced dark-brown urination which subsided after PQ discontinuation. G6PDd patients were treated with PQ 45 mg/week for eight weeks while PQ was discontinued in one case with G6PD 1.4 U/g Hb due to complaint of reddish-brown coloured urine by 48 hours of PQ initiation. Nested polymerase chain reaction test revealed 45 (28%) cases as mixed (vivax and falciparum) malaria.
The CQ-PQ combined regimen remains outstandingly effective to treat uncomplicated P. vivax malaria in Udupi taluk and thus it should continue as first line regimen. For all P. vivax cases, G6PD screening before PQ administration must be mandatory and made available in all PHCs.
东南亚国家已发表了几篇关于间日疟原虫疟疾氯喹治疗失败和耐药性的报告。本研究旨在评估氯喹-伯氨喹（CQ-PQ）联合疗法对印度卡纳塔克邦乌度皮县乌度皮乡选定初级卫生保健中心（PHC）所诊治的间日疟原虫疟疾患者的疗效。
根据规模比例概率在乌度皮乡内选择了5个初级卫生保健中心。按照世界卫生组织的方案，对经显微镜诊断为单纯间日疟原虫感染队列的患者进行为期28天的随访，以评估CQ（3天内1500毫克）加PQ（14天内210毫克）疗法的体内治疗效果。
该研究共招募了161名参与者，其中155名（96.3%）参与者完成了直至第28天的随访，完全遵守治疗方案，并显示出足够的临床和寄生虫学反应。有5名（3.1%）参与者失访，1名（0.6%）参与者未遵守治疗方案。在5名（3.1%）参与者中发现葡萄糖-6-磷酸脱氢酶缺乏症（G6PDd，正常平均活性的<30%），其中1人确实出现了PQ诱导的深褐色尿液，在停用PQ后消退。G6PDd患者接受每周45毫克PQ治疗8周，而1例G6PD为1.4 U/g Hb的患者在开始服用PQ 48小时后因出现红棕色尿液的主诉而停用PQ。巢式聚合酶链反应检测显示45例（28%）为混合（间日疟和恶性疟）疟疾。
CQ-PQ联合疗法在乌度皮乡治疗非复杂性间日疟原虫疟疾方面仍然非常有效，因此应继续作为一线治疗方案。对于所有间日疟原虫病例，在服用PQ前必须强制进行G6PD筛查，并在所有初级卫生保健中心提供。
