TINJAUAN PUSTAKA METODE PENENTUAN RESISTENSI PLASMODIUM VIVAX TERHADAP KLOROKUIN Nurhayati
Bagian Parasitologi Fakultas Kedokteran Universitas Andalas
Klorokuin merupakan obat pilihan pertama selama lebih kurang 50 tahun
untuk pengobatan malaria vivax, karena kerjanya cepat, murah, dan aman diberikan pada bayi dan wanita hamil. Sejak 1989 muncul beberapa laporan resistensi P. vivax terhadap klorokuin, yang sebagian besar berasal dari Papua Nugini dan Indonesia, namun kesimpulan tentang resistensi belum dapat diperoleh karena cara/metode yang digunakan dalam penentuan resistensi belum seragam. Uji invivo pada prinsipnya menilai efikasi klorokuin dosis standar terhadap P. vivax yang di follow up selama 28 hari dengan menggunakan parasitemia dan gejala klinis sebagai parameternya. Dikatakan resisten, bila parasitemia menetap atau muncul kembali pada kurun waktu tersebut. Keputusan resistensi seharusnya disertai dengan pemeriksaan kadar klorokuin dalam darah untuk menghindari salah penafsiran. Kadar klorokuin dalam darah > 100 ng/ml dianggap dapat mengeliminasi P. vivax strain sensitif dari darah. Bila kadar klorokuin sewaktu terjadi rekurens melebihi kadar efektif minimum, dapat dikatakan parasit sudah resisten. Walaupun sudah banyak laporan tentang resistensi P. vivax terhadap klorokuin, namun klorokuin masih dijadikan pilihan pertama dalam pengobatan malaria vivax sampai benar-benar terbukti P. vivax resisten dengan klorokuin. Kata kunci : P. vivax, resistensi, klorokuin. Abstract
Chloroquine has been a drug of choice for vivax malaria for about 50 years, as
it has a rapid onset of action, inexpensive, and safe for babies and pregnant women. There have been some reports regarding resistant P. vivax to chloroquine since 1989, which is mostly come from Papua New Guinea and Indonesia. However, it is not conclusive yet due to various different methods used. The invivo study, basically examined the efficacy of chloroquine standard dose on P. vivax monitored for 28 days using parasitemia and clinical sign as indicators. Resistance is diagnosed either by persistent parasitemia or recurrence occurred during monitoring period. Determination of resistance state should also be based on chloroquine level examination to avoid misinterpretation. The minimum level of chloroquine regarded as effective dose for P. vivax is 100 ng/ml. Serum chloroquine level of > 100 ng/ml is believed to be able to eliminate sensitive strain of P. vivax from blood. Although there have been many studies reporting the allegation of P. vivax resistance to chloroquine, chloroquine still as a drug of choice in vivax malaria treatment until
the P. vivax resistance to chloroquine established. If resistance has been established, chloroquine needs to be replaced by other alternative drugs, like a mefloquine, halofantrine, quinine or combination of chloroquine plus primaquine.
Keywords: P. vivax, Resistance, Chloroquine.
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