Halofantrine and primaquine for radical cure of malaria in Irian Jaya, Indonesia.
The combination of halofantrine and primaquine therapies was calculated as a regimen for achieving radical curve of falciparum or vivax malaria in Irian Jaya, Indonesia, and compared with combined chloroquine and primaquine therapies. The patients who volunteered for the study [adult, male, Indonesian immigrants with no previous exposure to endemic malaria, normal glucose-6-phosphate dehydrogenase (G6PD) activity, uncomplicated malaria illness, no prior use of antimalarials, and parasitaemias of 0.001%-1.1%] were randomized to receive either halofantrine (24 mg base/kg bodyweight, in three equal doses over 12 h) or chloroquine (25 mg base/kg bodyweight over 48 h, in doses of 10, 10 and 5 mg base/kg at 24-h intervals). Each patient also received concurrent daily primaquine (0.5 mg base/kg bodyweight) for 14 days followed by the same dose on alternate days to day 28. A recurrent parasitaemia during the 28 days of follow-up constituted drug failure. Of the 40 cases of falciparum malaria and 26 cases of vivax malaria treated with halofantrine-primaquine, none had a recurrent parasitaemia (100% efficacy). In contrast, 20 of 30 patients with falciparum malaria and three of 27 with vivax malaria had recurrent parasitaemias after chloroquine-primaquine, giving efficacies of 33% and 89%, respectively. Halofantrine-primaquine was significantly more effective than chloroquine-primaquine against falciparum malaria (P < 0.001) but was similarly efficacious against vivax malaria (P = 0.23). On average, fever associated with falciparum or vivax malaria cleared 17 h faster with halofantrine-primaquine (P < 0.01) although there were no significant differences (P > 0.4) in parasite-clearance times between the two regimens. The halofantrine-primaquine regimen was also associated with a more rapid and significant decline in malaria-related physical complaints.
Fryauff
D J
DJ
U.S. NAMRU-2 (Jakarta), USA. fryauff@smtp.namru2.go.id
Baird
J K
JK
Basri
H
H
Wiady
I
I
Purnomo
Bangs
M J
MJ
Subianto
B
B
Harjosuwarno
S
S
Tjitra
E
E
Richie
T L
TL
Hoffman
S L
SL
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D002738:Chloroquine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007214:Indonesia; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000503:physiopathology; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D018512:Parasitemia / Q000188:drug therapy; D010616:Phenanthrenes / Q000627:therapeutic use*; D011319:Primaquine / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
D000962:Antimalarials; D010616:Phenanthrenes; D002738:Chloroquine; D011319:Primaquine; C023768:halofantrine