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