Comparative Study of Effectiveness and Resistance Profile of Chloroquine and Sulfadoxine-Pyrimethamine in Uncomplicated Plasmodium falciparum Malaria in Kolkata.

INTRODUCTION Malaria is one of the major public health problems of the country. Factors responsible for reemergence of malaria in India was due to emergence and spread of chloroquine resistant Plasmodium falciparum strains across the country coupled with steady rise in insecticide resistance of the vector mosquitoes. Very little is known about the drug resistance status of P. falciparum in India. As per National Vector Borne Diseases Control Programme (NVBDCP), chloroquine is the drug of choice for uncomplicated P. falciparum cases and the combination of Artesunate and Sulfadoxine-Pyrimethamine (SP) is being used to treat the documented chloroquine-resistant uncomplicated cases. To evaluate the comparative effectiveness and resistance profile of Chloroquine vis-à-vis Sulfadoxine-Pyrimethamine (SP) in uncomplicated Plasmodium falciparum cases as the first-line therapy a study was undertaken at the Malaria Clinic of Calcutta School of Tropical Medicine, Kolkata during the period from July 2007 to December 2007 at Kolkata Municipal Corporation, Kolkata. MATERIAL & METHODS Following WHO protocol 2003, a total of 100 parasitologically confirmed Plasmodium falciparum cases were recruited as per the recruitment criteria. Among them, 50 patients were given Chloroquine and another 50 patients were given SP. Eight patients were excluded or lost to follow-up during the follow-up period because of failure to follow the protocol. RESULTS It was observed that in the Chloroquine group out of 50 patients, 30 (60%) showed adequate clinical and parasitological response (ACPR), 15 (30%) had late treatment failure (LTF) and remaining 5 (10%) were lost during the follow up period (LFU). On the other hand in the SP group out of 50 patients, 46 (92%) showed ACPR and only one (2%) had LTF and 3 patients were LFU. The difference of LTF in Chloroquine and Sulfadoxine-pyrimethamine groups was statistically significant (p value < 0.05). Also there was statistically significant difference of the mean parasite clearance time (PCT) of Chloroquine (82.7 hours) and SP group (61.3 hours). CONCLUSIONS Chloroquine failure rate was high which was well above the WHO recommended cut off threshold for drug policy change (> 10%), Sulfadoxine- Pyrimethamine can be used in place of Chloroquine as the first line drug in uncomplicated P. falciparum cases.