The susceptibility of Plasmodium falciparum to chloroquine, quinine, mefloquine and halofantrine was investigated in the Central Province of Papua New Guinea between March 1995 and September 1996, when chloroquine resistance was widely present in the country. The standard World Health Organization in vitro microtest methodology was used in the study. Of the 30 isolates tested for chloroquine susceptibility all were resistant to chloroquine with median IC50 of 1.15 mumol/l (range 0.54 to 4.24), indicating a high prevalence and degree of resistance. Three isolates each for quinine (3/31) and halofantrine (3/28) showed resistance at concentrations of 51.2 mumol/l and 10 nM respectively, while all 31 isolates tested for mefloquine were fully susceptible. The comparative analysis of median IC50 values between isolates resistant and susceptible to chloroquine showed chloroquine-resistant isolates to be less susceptible to quinine and halofantrine while fully susceptible to mefloquine. It seems that the evolution of chloroquine resistance together with increased use of quinine treatment of P. falciparum malaria may increase the risk of emergence of quinine resistance and possibly of halofantrine resistance as well. The development of mefloquine resistance, however, is independent of chloroquine resistance.
Antimalarials - pharmacology ; Chloroquine - pharmacology ; Drug Resistance, Microbial ; Mefloquine - pharmacology ; Microbial Sensitivity Tests ; Papua New Guinea

The aim of the present study was to investigate antimalarial drug pressure resulting from the clinical use of different antimalarials in Thailand. The phenotypic diversity of the susceptibility profiles of antimalarials, i.e., chloroquine (CQ), quinine (QN), mefloquine (MQ), and artesunate (ARS) in Plasmodium falciparum isolates collected during the period from 1988 to 2003 were studied. P. falciparum isolates from infected patients were collected from the Thai-Cambodian border area at different time periods (1988-1989, 1991-1992, and 2003), during which 3 different patterns of drug use had been implemented: MQ + sulphadoxine (S) + pyrimethamine (P), MQ alone and MQ + ARS, respectively. The in vitro drug susceptibilities were investigated using a method based on the incorporation of [3H] hypoxanthine. A total of 50 isolates were tested for susceptibilities to CQ, QN, MQ, and ARS. Of these isolates, 19, 16, and 15 were adapted during the periods 1988-1989, 1991-1993, and 2003, respectively. P. falciparum isolates collected during the 3 periods were resistant to CQ. Sensitivities to MQ declined from 1988 to 2003. In contrast, the parasite was sensitive to QN, and similar sensitivity profile patterns were observed during the 3 time periods. There was a significantly positive but weak correlation between the IC50 values of CQ and QN, as well as between the IC50 values of QN and MQ. Drug pressure has impact on sensitivity of P. falciparum to MQ. A combination therapy of MQ and ARS is being applied to reduce the parasite resistance, and also increasing the efficacy of the drug.
Animals ; Antimalarials/*pharmacology/therapeutic use ; Artemisinins/pharmacology/therapeutic use ; Chloroquine/pharmacology/therapeutic use ; *Drug Resistance ; Humans ; Malaria/drug therapy/*parasitology ; Mefloquine/pharmacology/therapeutic use ; Parasitic Sensitivity Tests/methods ; Plasmodium falciparum/*drug effects/isolation & purification ; Quinine/pharmacology/therapeutic use ; Thailand

Artemisinin-based combination therapy (ACT) is currently promoted as a strategy for treating both uncomplicated and severe falciparum malaria, targeting asexual blood-stage Plasmodium falciparum parasites. However, the effect of ACT on sexual-stage parasites remains controversial. To determine the clearance of sexual-stage P. falciparum parasites from 342 uncomplicated, and 217 severe, adult malaria cases, we reviewed and followed peripheral blood sexualstage parasites for 4 wk after starting ACT. All patients presented with both asexual and sexual stage parasites on admission, and were treated with artesunate-mefloquine as the standard regimen. The results showed that all patients were asymptomatic and negative for asexual forms before discharge from hospital. The percentages of uncomplicated malaria patients positive for gametocytes on days 3, 7, 14, 21, and 28 were 41.5, 13.1, 3.8, 2.0, and 2.0%, while the percentages of gametocyte positive severe malaria patients on days 3, 7, 14, 21, and 28 were 33.6, 8.2, 2.7, 0.9, and 0.9%, respectively. Although all patients were negative for asexual parasites by day 7 after completion of the artesunate-mefloquine course, gametocytemia persisted in some patients. Thus, a gametocytocidal drug, e.g., primaquine, may be useful in combination with an artesunate-mefloquine regimen to clear gametocytes, so blocking transmission more effectively than artesunate alone, in malaria transmission areas.
Adolescent ; Adult ; Animals ; Antimalarials/*pharmacology/therapeutic use ; Artemisinins/*pharmacology/therapeutic use ; Drug Evaluation ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Germ Cells/*drug effects/growth & development ; Humans ; Malaria, Falciparum/*drug therapy/parasitology ; Male ; Mefloquine/*pharmacology/therapeutic use ; Plasmodium falciparum/*drug effects/growth & development ; Severity of Illness Index ; Thailand ; Treatment Outcome