drug resistance monitoring in cambodia 1997 - 2003
TRANSCRIPT
Drug Resistance Monitoring
in Cambodia 1997 - 2003
Sensitivity (S or S/RI) at 4 Sensitivity (S or S/RI) at 4 sentinel sites 1991 – 97sentinel sites 1991 – 97
Western areas: Western areas: Battambang, Pursat, Battambang, Pursat, Eastern areas:Eastern areas: Ratanakiri, KratieRatanakiri, Kratie
Chloroquine Chloroquine --1991-93 (West): 1991-93 (West): S or S/RI = 3-12% S or S/RI = 3-12% -1997 (East): -1997 (East): S/RI = 76%-86%S/RI = 76%-86%
Fansidar® Fansidar® -1991-95 (West): -1991-95 (West): S or S/RI = 0-13%S or S/RI = 0-13%-1991-95 (East): -1991-95 (East): S or S/RI = 57-80%S or S/RI = 57-80%
Quinine and TetracyclineQuinine and Tetracycline-1994-95 (All areas):S/RI = 100 %-1994-95 (All areas):S/RI = 100 %
Mefloquine monotherapy:Mefloquine monotherapy:-1991-97 (West): -1991-97 (West): S or S/RI = 80%-97%S or S/RI = 80%-97%-1992-97 (East): -1992-97 (East): S or S/RI = 100%S or S/RI = 100%
Drug Resistance Monitoring in Cambodia 1998
No studyNo study Lack of budgetLack of budget Lack of human Lack of human
resourcesresources
due to Denguedue to Dengue
epidemic outbreakepidemic outbreak
S/RI68%
R32%
Mefloquine25mg
Drug Resistance of Chloroquine & Mefloquine Monotherapy 1999
Sampov Loun
Rovieng
S/RI76%
R24%
Mefloquine25mg
S/RI66%
R34%
R40%
S/RI60%
Chloroquine
Chloroquine
Mefloquine25mg/kgw
S/RI100%
R3%
S/RI97%
Mefloquine25mg/kgw
Drug Resistance Artecomin Cambodia 1999
R4%
S96%
Sampov Loun
snoul
S100%
Artecom(Art.+piperaq.+trimethoprime) 2days,28days follow up
Drug Resistance of A+M in Cambodia 2000
Sampov Loun
Oral,Kg Speu
S/RI100%
S/RI100%
Samlot
Snoul
Drug Resistance of A+M Monitoring2001LTF
2%
ACPR98%
S/RI100%
Drug Resistance of Artekine 2 & Coarterm 2001
Anlong Veng
LTF7%
ACPR93%
Artekine2
42
3
LTF8%
ACPR92%
Artekine2
56
5LTF28%
ACPR72%
Coarterm
38
15
ACPR, 88%
LTF, 12%
N=82
LTF6%
ACPR94%
Drug Resistance Monitoring A+M in Cambodia 2002 LTF
3%
ACPR97%
ACPR100%
N=36
N=75
Preah Vihear
Pailin
Veal Veng
Ratanakiri
Snoul
Drug Resistance of Artekine 2 & Coarterm in Cambodia 2002
Sampov Loun
SnoulLTF27%
ACPR73%
Coarterm
N=55
ACPR100%
N=65
Artekine 2
.
Drug Resistance Monitoring A+M in Cambodia 2003
Name of sites
No. of
enrollment
Drop out ACPR LTF
Oral 97
(64.7%)
06
(6.2%)
88
(96.7%)
03 a
(3.3%)
Anlong Veng
92
(61%)
02
(2.2%)
88
(97.8%)
02 b
(2.2%)
Snoul 66
(41.8%)
03
(4.5%)
63
(100%)
0
Sampov loun
55
(21%)
03
(5.5%)
48
(92.7%)
4 c
(7.3%) a = PCR confirmed all cases are recrudescing
b = Showed that both are re – infection
c = PCR confirmed all cases are recrudescing
PCR were done by Institute Pasteur of Cambodia
Drug Resistance Monitoring at sentinel sites, Cambodia 2002 & 2003
Year Name of sites No. of
enrollment
ACPR (%) LTF (%)
2002 Pailin 82 88 12
2002 Pursat 88 94 6
2002 Prah vihear 36 97 3
2002 Rattanakiri 75 100 0
2003 Battambang 55 92.7 7.7
2003 Kg. Speu 97 96.7 3.3
2003 Kratie 66 100 0
2003 O. M. Chey 92 97.8 2.2
Sentinel sites of drug resistance Sentinel sites of drug resistance monitoring in Cambodiamonitoring in Cambodia
Conclusion
The result showed the sensitivity of A+M still high (ACPR = 92 – 100%) each sentinel site if we compared to the result of previous study.
So The A+M can be continue as drug for our first line treatment of malaria.
Test systemTest systemDays 0 1 2 3 7 14 21 28 Othe
r
day
Clinical examination X X X X X X X X X
Axillary Temperature X X X X X X X X X
Treatment A+M
A=12mg/kg, for 3days
M=25mg/kg on day0
X
A+M
X
A
X
A
Parasitemia X X X X X X X X X
Blood spot (PCR)
Blood sampling
( For In Vitro test)
X
X
X X X
Thank you for your attention