Assessment of the efficacy of antimalarial drugs in Tarapacá, in the Colombian Amazon basin
Keywords:
malaria, falciparum/prevention & control, malaria vivax/prevention & control, drug therapy, Amazonian ecosystem, Colombia
Abstract
Introduction. The current antimalarial drug policy in Colombia has been based on studies conducted in Antioquia and the Pacific Coast. However, the efficacy of antimalarial drugs in other endemic regions is unknown.Objective. The therapeutic efficacy of three monotherapies was assessed: amodiaquine and sulfadoxine/pyrimethamine for uncomplicated Plasmodium falciparum malaria, and chloroquine for Plasmodium vivax malaria in the municipality of Tarapacá, located in the Colombian province of Amazonas.
Materials and methods. Treatment was supervised and clinical/parasitological follow-up was undertaken through a 28-day period following to World Health Organization standard protocols for subjects with a single P. falciparum or P. vivax infection.
Results. Due to a decrease in malaria transmission at the time of the study, the sample size was very small. The treatment failed for two subjects who received amodiaquine, and treatment with sulfadoxine/pyrimethamine was discontinued due to a high frequency of therapeutic failures (7/8). Most subjects (18/20) with P. vivax infections showed an adequate therapeutic response.
Conclusions. The use of sulfadoxine/pyrimethamine in Tarapacá, and possibly in the Amazon region of Colombia, needs to be reviewed. Therapeutic efficacy studies in other endemic areas in the Amazon and Orinoco regions in Colombia are desirable but not feasible. Alternative methods such as in vitro assays or detection of molecular markers for resistance in the parasite can provide a basis for decisions concerning antimalarial drug policy for the Amazon and Orinoco regions in Colombia.
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References
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13. Soto J, Toledo J, Gutiérrez P, Luzz M, Llinas N, Cedeño N et al. Plasmodium vivax clinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 2001;65:90-3.
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17. Magris M, Riggione F. Susceptibilidad del Plasmodium falciparum in vitro a la cloroquina, amodiaquina, quinina y pirimetamina-sulfadoxina en el estado Amazonas, Venezuela. Acta Científica Venezolana 1994;45 (Supl 1):250.
18. Blair S, Carmona-Fonseca J, Piñeros JG, Ríos A, Álvarez T, Álvarez G et al. Therapeutic efficacy test in malaria falciparum in Antioquia, Colombia. Malar J 2006;5:14.
19. Méndez F, Muñoz A, Carrasquilla G, Jurado D, Arevalo-Herrera M, Cortese J et al. Determinants of treatment response to sulfadoxine-pyrimethamine and subsequent transmission potential in falciparum malaria. Am J Epidemiol 2002;156:230-8.
20. Noedl H, Wongsrichanalai C, Wernsdorfer WH. Malaria drug-sensitivity testing: new assays, new perspectives. Trends Parasitol 2003;19:175-81.
21. Kublin J, Richard W, Shankar A, Quintana J, Gilman R, Aramburu J et al. Molecular assays for surveillance of antifolate-resistance malaria. Lancet 1998;351:1629.
22. Plowe CV, Cortese JF, Djimde A, Nwanyanwu OC, Watkins WM, Winstanley P et al. Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase and epidemiologic patterns
of pyrimethamine-sulfadoxine use and resistance. J Infect Dis 1997;176:1590-6.
2. Moore DV, Lanier JE. Observations of two Plasmodium falciparum infections with an abnormal response to chloroquine. Am J Trop Med Hyg 1961;10:5-9.
3. López Y, Arroyave A, Salazar A. Evaluación de la resistencia in vivo a los medicamentos antimaláricos El Bagre, Antioquia, 1998. Rev Epidemiol Antioquia 1999;24:181-94.
4. Blair S, Lacharme L, Carmona J, Tobón A. Resistencia de Plasmodium falciparum a tres fármacos antimaláricos en Turbo (Antioquia, Colombia) 1998. Rev Panam Salud Pública 2001;9:23-9.
5. Blair S, Lacharme-Lora L, Carmona-Fonseca J. Resistance of Plasmodium falciparum to antimalarial drugs in Zaragoza (Antioquia, Colombia), 1998. Mem Inst Oswaldo Cruz 2002;97:401-6.
6. Castillo CM, Osorio LE, Palma GI. Assessment of the therapeutic response of Plasmodium vivax and Plasmodium falciparum to chloroquine in a malaria transmission free area in Colombia. Mem Inst Oswaldo Cruz 2002;97:559-62.
7. Osorio LE, Giraldo LE, Grajales LF, Arriaga AL, Andrade AL, Ruebush TK 2nd et al. Assessment of therapeutic response of Plasmodium falciparum to chloroquine and sulfadoxine/pyrimethamine in a low malaria transmission area in Colombia. Am J Trop Med Hyg 1999;61:968-72.
8. Ministerio de Salud de Colombia. Guía de atención clínica para el diagnóstico y tratamiento de la malaria. Bogotá: Ministerio de Salud; 1999.
9. Alecrim M das G, Alecrim WD, de Albuquerque BC, Dourado HV, Wanssa M do C. Resistance of Plasmodium falciparum in the Brazilian Amazonas to the combination of sulfadoxine and pyrimethamine. Rev Inst Med Trop Sao Paulo 1982;24 (6 suppl):44-7.
10. Magill AJ, Zegarra J, Garcia C, Marquino W, Ruebush TK 2nd. Efficacy of sulfadoxine-pyrimethamine and mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon
basin of Peru. Rev Soc Bras Med Trop 2004;37:279-81.
11. Alecrim M das G, Alecrim W, Macedo V. Plasmodium vivax resistance to chloroquine (R2) and mefloquine (R3) in Brazilian Amazon region. Rev Soc Bras Med Trop 1999;32:67-8.
12. Baird JK, Wiady I, Fryauff DJ, Sutanihardja MA, Leksana B, Widjaya H et al. In vivo resistance to chloroquine by Plasmodium vivax and Plasmodium falciparum at Nabire, Irian Jaya, Indonesia. Am J Trop Med Hyg 1997;56:627-31.
13. Soto J, Toledo J, Gutiérrez P, Luzz M, Llinas N, Cedeño N et al. Plasmodium vivax clinically resistant to chloroquine in Colombia. Am J Trop Med Hyg 2001;65:90-3.
14. World Health Organization. Assessment and monitoring of antimalarial drug efficacy for the treatment of of uncomplicated P. falciparum malaria. Report No.: WHO/HTM/RBM/2003.50. Geneva: WHO; 2003.
15. World Health Organization/Pan American Health Organization. Assessment of therapeutic efficacy of medicaments to treat uncomplicated P. falciparum malaria in the Americas. Report No.: PS/HCP/HCT/113/98. Washington: WHO, OPS; 1998.
16. Espinal CA, Cortes GT, Guerra P, Arias AE. Sensitivity of Plasmodium falciparum to antimalarial drugs in Colombia. Am J Trop Med Hyg 1985;34:675-80.
17. Magris M, Riggione F. Susceptibilidad del Plasmodium falciparum in vitro a la cloroquina, amodiaquina, quinina y pirimetamina-sulfadoxina en el estado Amazonas, Venezuela. Acta Científica Venezolana 1994;45 (Supl 1):250.
18. Blair S, Carmona-Fonseca J, Piñeros JG, Ríos A, Álvarez T, Álvarez G et al. Therapeutic efficacy test in malaria falciparum in Antioquia, Colombia. Malar J 2006;5:14.
19. Méndez F, Muñoz A, Carrasquilla G, Jurado D, Arevalo-Herrera M, Cortese J et al. Determinants of treatment response to sulfadoxine-pyrimethamine and subsequent transmission potential in falciparum malaria. Am J Epidemiol 2002;156:230-8.
20. Noedl H, Wongsrichanalai C, Wernsdorfer WH. Malaria drug-sensitivity testing: new assays, new perspectives. Trends Parasitol 2003;19:175-81.
21. Kublin J, Richard W, Shankar A, Quintana J, Gilman R, Aramburu J et al. Molecular assays for surveillance of antifolate-resistance malaria. Lancet 1998;351:1629.
22. Plowe CV, Cortese JF, Djimde A, Nwanyanwu OC, Watkins WM, Winstanley P et al. Mutations in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase and epidemiologic patterns
of pyrimethamine-sulfadoxine use and resistance. J Infect Dis 1997;176:1590-6.
How to Cite
1.
Osorio L, Pérez L del P, González IJ. Assessment of the efficacy of antimalarial drugs in Tarapacá, in the Colombian Amazon basin. Biomed. [Internet]. 2007 Mar. 1 [cited 2025 Apr. 11];27(1):133-40. Available from: https://revistabiomedicaorg.biteca.online/index.php/biomedica/article/view/239
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Published
2007-03-01
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Section
Short communication
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