Chloroquine remains the drug of choice for the treatment of vivax malaria in Thailand. Mixed infections of falciparum and vivax malaria are also common in South-East Asia. Laboratory confirmation of malaria species is not generally available. This study aimed to find alternative regimens for treating both malaria species by using falciparum antimalarial drugs. From June 2004 to May 2005, 98 patients with Plasmodium vivax were randomly treated with either artemether-lumefantrine (n = 47) or chloroquine (n = 51). Both treatments were followed by 15 mg of primaquine over 14 days. Adverse events and clinical and parasitological outcomes were recorded and revealed similar in both groups. The cure rate was 97.4% for the artemether-lumefantrine treated group and 100% for the chloroquine treated group. We concluded that the combination of artemether-lumefantrine and primaquine was well tolerated, as effective as chloroquine and primaquine, and can be an alternative regimen for treatment of vivax malaria especially in the event that a mixed infection of falciparum and vivax malaria could not be ruled out.
Adolescent ; Aged ; Animals ; Antimalarials/adverse effects/*therapeutic use ; Artemisinins/adverse effects/*therapeutic use ; Chloroquine/adverse effects/*therapeutic use ; Drug Therapy, Combination ; Ethanolamines/adverse effects/*therapeutic use ; Female ; Fluorenes/adverse effects/*therapeutic use ; Humans ; Malaria, Vivax/*drug therapy ; Male ; Middle Aged ; Parasitemia ; Plasmodium vivax/drug effects ; Primaquine/therapeutic use ; Thailand ; Treatment Outcome

Liver function tests were performed in 61 vivax, 54 malariae and 15 ovale malaria patients who were admitted to Bangkok Hospital for Tropical Diseases between 2001 and 2004. The objective of the study was to evaluate changes in hepatic biochemical indices before and after treatment with artemisinin derivatives. On admission and prior to treatment, hepatic dysfunction was found among the 3 groups. Serum liver function tests and physical examinations were performed weekly during the 28-day follow-up period. Initially elevated serum bilirubin and diminished albumin returned to normal within 2 weeks of treatment. Serum alkaline phosphatase and aminotransferases returned to within normal limits within 3 weeks. We conclude that patients with Plasmodium vivax, P. malariae and P. ovale infections had slightly elevated serum bilirubin, aminotransferase and alkaline phosphatase levels, and hypoalbuminemia. These minor abnormalities returned to normal within a few weeks after treatment with therapies based on artemisinin derivatives.
Treatment Outcome ; Sesquiterpenes/*therapeutic use ; Serum Albumin ; Plasmodium vivax/*drug effects/pathogenicity ; Plasmodium ovale/*drug effects/pathogenicity ; Plasmodium malariae/*drug effects/pathogenicity ; Middle Aged ; Male ; Malaria, Vivax/drug therapy/parasitology/physiopathology ; Malaria/*drug therapy/parasitology/physiopathology ; Liver Function Tests ; Liver/*physiopathology ; Humans ; Female ; Bilirubin/blood ; Artemisinins/*therapeutic use ; Anti-Infective Agents/therapeutic use ; Animals ; Alanine Transaminase/blood ; Adult ; Adolescent