title: Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India.
abstract: BACKGROUND
  Of late there have been accounts of therapeutic failure and chloroquine resistance in Plasmodium vivax malaria especially from Southeast Asian regions. The present study was conducted to assess the therapeutic efficacy of chloroquine-primaquine (CQ-PQ) combined regimen in a cohort of uncomplicated P. vivax mono-infection.
  
  
  METHODS
  A tertiary care hospital-based prospective study was conducted among adult cohort with mono-infection P. vivax malaria as per the World Health Organization's protocol of in vivo assessment of anti-malarial therapeutic efficacy. Participants were treated with CQ 25 mg/kg body weight divided over 3 days and PQ 0.25 mg/kg body weight daily for 2 weeks.
  
  
  RESULTS
  Of a total of 125 participants recruited, 122 (97.6%) completed day 28 follow up, three (2.4%) participants were lost to follow-up. Eight patients (6.4%) were ascertained to have mixed P. vivax and Plasmodium falciparum infection by nested polymerase chain reaction test. The majority of subjects (56.8%, 71/125) became aparasitaemic on day 2 followed by 35.2% (44/125) on day 3, and 8% (10/125) on day 7, and remained so thereafter. Overall only one therapeutic failure (0.8%, 1/125) occurred on day 3 due to persistence of fever and parasitaemia.
  
  
  CONCLUSIONS
  CQ-PQ combined regimen remains outstandingly effective for uncomplicated P. vivax malaria and should be retained as treatment of choice in the study region. One case of treatment failure indicates possible resistance which warrants constant vigilance and periodic surveillance.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. rishikeshkumar@live.in.
authors.forename: Kumar
authors.initials: K
authors.lastname: Rishikesh
authors.affiliation: Department of Community Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, India. aashakamat@gmail.com.
authors.forename: Asha
authors.initials: A
authors.lastname: Kamath
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. mhhande@yahoo.com.
authors.forename: Manjunatha H
authors.initials: MH
authors.lastname: Hande
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. vsagar33@yahoo.com.
authors.forename: Sudha
authors.initials: S
authors.lastname: Vidyasagar
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. ravi.katte@gmail.com.
authors.forename: Raviraja V
authors.initials: RV
authors.lastname: Acharya
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. acharyavasudev@yahoo.com.
authors.forename: Vasudeva
authors.initials: V
authors.lastname: Acharya
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. drjpbelle@yahoo.co.in.
authors.forename: Jayaprakash
authors.initials: J
authors.lastname: Belle
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. shastryba@yahoo.co.in.
authors.forename: Ananthakrishna B
authors.initials: AB
authors.lastname: Shastry
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, 576104, Karnataka, India. kavithasaravu@gmail.com.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Saravu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use*; D060085:Coinfection; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D016778:Malaria, Falciparum; D016780:Malaria, Vivax / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D010966:Plasmodium vivax / Q000235:genetics*; D016133:Polymerase Chain Reaction; D011319:Primaquine / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D063128:Tertiary Health Care; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000962:Antimalarials; D002738:Chloroquine; D011319:Primaquine