Evaluation of artemisinin-based combination therapy (ACT) to uncomplicated falciparum malaria patients in Purworejo District, Central Java, Indonesia

Abstract

Artemisinin-based Combination Therapy (ACT) to treat uncomplicated Plasmodium falciparum malaria has been applied in Purworejo District, Central Java, Indonesia, since 2004. However evaluation of the two ACT regimens used ie: Artesunate Amodiaquine (AAQ) and Dihydroartemisinin-Piperaquine (DHP) co-administered with Primaquine (PQ) has not been performed. This study aims to evaluate the efficacy and side effects of AAQ+PQ and DHP+PQ treatment in uncomplicated falciparum malaria in Purworejo. In this descriptive and observational study, 46 Pf infected patients who fullfill the inclusion and exclusion criterias were recruited from December 2010 to August 2011. Standard ACT treatment were given to the patients followed by WHO drug efficacy evaluation for 28 days. The clinical symptoms and adverse events was also evaluated over the course of the treatment. From all recruited subjects, 37 patients received DHP+PQ and 9 patients received AAQ+PQ. On the DHP+PQ treated patient, all subjects were free of asexual and sexual parasites by Day-3 while on AAQ+PQ treated patient, this parasite clearance was achieved faster as early as on D-2 at the latest. On the otherhand, the disappearance of fever was also last longer in DHP+PQ treated patient which in one patient last on D-14, while in AAQ+PQ treated patient, the symptom of fever dissappeared by D-2 at the latest. No Early or Late Treatment Failures were found on either DHP+PQ or AAQ+PQ treatment as well as clinical and parasitological failures. However, the presence of adverse events cause by both drugs should not be ignored to ensure drug compliance.