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Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis

Price, Ric N., von Seidlein, Lorenz, Valecha, Neena, Nosten, Francois, Baird, J. Kevin and White, Nicholas J. (2014). Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis. Lancet Infectious Diseases,14(10):982-991.

Document type: Journal Article
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IRMA ID 84473306xPUB5
Title Global extent of chloroquine-resistant Plasmodium vivax: a systematic review and meta-analysis
Author Price, Ric N.
von Seidlein, Lorenz
Valecha, Neena
Nosten, Francois
Baird, J. Kevin
White, Nicholas J.
Journal Name Lancet Infectious Diseases
Publication Date 2014
Volume Number 14
Issue Number 10
ISSN 1473-3099   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84908134087
Start Page 982
End Page 991
Total Pages 10
Place of Publication United Kingdom
Publisher The Lancet Publishing Group
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Chloroquine is the first-line treatment for Plasmodium vivax malaria in most endemic countries, but resistance is increasing. Monitoring of antimalarial efficacy is essential, but in P vivax infections the assessment of treatment efficacy is confounded by relapse from the dormant liver stages. We systematically reviewed P vivax malaria treatment efficacy studies to establish the global extent of chloroquine resistance.


We searched Medline, Web of Science, Embase, and the Cochrane Database of Systematic Reviews to identify studies published in English between Jan 1, 1960, and April 30, 2014, which investigated antimalarial treatment efficacy in P vivax malaria. We excluded studies that did not include supervised schizonticidal treatment without primaquine. We determined rates of chloroquine resistance according to P vivax malaria recurrence rates by day 28 whole-blood chloroquine concentrations at the time of recurrence and study enrolment criteria.


We identified 129 eligible clinical trials involving 21 694 patients at 179 study sites and 26 case reports describing 54 patients. Chloroquine resistance was present in 58 (53%) of 113 assessable study sites, spread across most countries that are endemic for P vivax. Clearance of parasitaemia assessed by microscopy in 95% of patients by day 2, or all patients by day 3, was 100% predictive of chloroquine sensitivity.


Heterogeneity of study design and analysis has confounded global surveillance of chloroquine-resistant P vivax, which is now present across most countries endemic for P vivax. Improved methods for monitoring of drug resistance are needed to inform antimalarial policy in these regions
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