Uji efikasi obat anti malaria Coartem, Sulfadoksin Pirimetamin + Primakuin, dan Klorokuin + Primakuin pada penderita malaria Falsiparum di Kecamatan Kokap, Kabupaten Kulon Progo Provinsi Daerah Istimewa Yogyakarta

ISMANTO, Buddy, Prof.dr. Soesanto TJ., M.CommH.DTM

2004 | Tesis | S2 Ilmu Kesehatan Masyarakat

Malaria merupakan masalah kesehatan di Kecamatan Kokap Kabupaten Kulon Progo. Sejak tahun 1995 P. falciparum telah resisten terhadap klorokuin dan digunakan obat sulfadoksin-pirimetamin+primakuin untuk mengobati malaria falsiparum. Di beberapa tempat juga telah dilaporkan adanya resistensi P. falciparum terhadap obat sulfadoksin-pirimetamin. Sejak tahun 2001 digunakan obat Coartem sebagai obat alternatif untuk mengobati malaria falsiparum di Kecamatan Kokap. Penelitian ini bertujuan untuk mendapatkan pengobatan malaria falsiparum yang paling efikasius. Jenis penelitian adalah eksperimental lapangan dengan rancangan randomized controlled trial (RCT).Penelitian ini dilakukan di Kecamatan Kokap Kabupaten Kulon Progo. Sebanyak 114 subjek penelitian, 97 subjek didapatkan dengan active case detection (ACD) dan 17 subjek dengan passive case detection (PCD).Kriteria inklusi: umur > 15 tahun, ada P. falciparum aseksual > 400/ml darah, tidak ada gametosit, tidak hamil, tidak menderita malaria berat/komplikasi, tidak ada riwayat alergi obat terhadap sulfadoksin, pirimetamin, klorokuin dan Coartem, bersedia diteliti selama 28 hari dengan menandatangani informed consent Subjek dibagi secara random ke dalam 3 kelompok pengobatan, masingmasing 38 subjek diberikan regimen sulfadoksin-pirimetamin+primakuin, klorokuin+primakuin dan Coartem. Pengamatan gejala klinis dan parasitologis dilakukan pada H-0, H-1, H-2, H-3, H-7, H-14, H-21 dan H-28. Evaluasi respon pengobatan dan gametositemia dilakukan pada 2 minggu pertama dan 2 minggu kedua setelah pengobatan. Hasil uji efikasi sampai pada evaluasi hari ke-14 menunjukkan respon pengobatan memadai regimen obat sulfadoksin-pirimetamin+primakuin, klorokuin+ primakuin dan Coartem masing-masing 65,8%, 63,2%, 92,1% sedangkan sampai pada evaluasi hari ke-28 sebesar 60,5%, 55,3% dan 89,5%. Gametositemia sampai pada evaluasi hari ke -28 kelompok pengobatan sulfadoksin-pirimetamin+primakuin da n klorokuin+primakuin masing-masing sebesar 10,5%, sedangkan pada Coartem tidak ditemukan gametosit. Efek samping yang muncul akibat pemberian obat-obat tersebut antara lain mual, muntah, gatal pada kulit, gangguan penglihatan dan gangguan pendengaran. Respon pengobatan pada penemuan subjek secara aktif dan pasif serta hilangnya demam tidak ada perbedaan bermakna. Dari hasil tersebut disimpulkan regimen obat Coartem paling efikasius dan mampu mencegah gametositemia untuk mengobati penderita malaria falsiparum tanpa komplikasi dibandingkan dengan regimen obat sulfadoksin -pirimetamin+ primakuin dan klorokuin+primakuin. Tidak ada efek samping yang membahayakan subjek penelitian akibat pemberian obat-obat tersebut.

Malaria is still a problem in Kokap sub-district Kulon Progo district. Since 1995 P. falciparum has been resistant to chloroquine and sulfadoxine/pyrimethamine and primaquine have been used for falciparum malaria treatment. In several area, P. falciparum had been reported to be resistant to sulfadoxine/pyrimethamine. Since 2001 in Kokap sub-district Coartem has been used for alternative treament to falciparum malaria. This study was aimed at finding the most efficacious antimalaria against P. falciparum, among Coartem,combination chloroquine and primaquine and combination sulfadoxine/pyrimethamine and primaquine. The study was field experimental using a randomized controlled trial approach.This was conducted in Kokap sub-district in Kulon Progo district. One hundred and fourteen subjects were taken using active case detection amount ninety seven subjects and passive case detection amount seventeen subjects. Inclusion criteria of subjects: age > 15 years old, asexual P. falciparum > 400/ml blood, no gametocyte, not pregnant, not having complication of malaria or severe malaria, no history to allergy sulfadoxine/pyrimethamine, chloroquine, primaquine and Coartem, willing to be observed for 28 days and agreeing to take part in the study by signing an informed consent. The subjects were randomly divided into 3 groups of treatment, each (38 subjects) was given sulfadoxine/pyrimethamine and primaquine, chloroquine and primaquine, and Coartem. Observation on clinical symptoms and parasitological was done on D-0, D-1, D-2, D-7, D-14, D-21 and D-28. Evaluation of responses of treament and gametocytemia was done in the first 2 weeks (D-14) and the second 2 weeks (D- 28) after D -0 treatment. Evaluation on day 14 indicated that adequate clinical and parasitological response rates of sulfadoxine/pyr imethamine and primaquine, chloroquine and primaquine, and Coartem were 65,8%, 63,2% and 92,1% respectively, and in evaluation on day 28 the adequate treatment response rates were 60,5%, 55,3% and 89,5%. Evaluation on gametocytemia on day 28 showed 10,5% rates for combinationn sulfadoxine/pyrimethamine and primaqune and combination chloroquine and primaquine regiments, and 0% for Coartem regiment. The clinical manifestations of drug side effects detected were nausea, vomiting, itching, vision and hearing problems. The adequate treatment response were taken using active and passive, and fever clearance among three regiment of antimalaria not significantly different. It could be concluded that treatment using Coartem regiment to the uncomplicated falciparum malaria patient in Kokap sub-district showed the most efficacious as antimalarial and inhibited the appearance of gametocytes as compared to the treatment with sulfadoxine/pyrimethamine and primaquine, and chloroquine and primaquine. There were no

Kata Kunci : Epidemiologi Lapangan, Penderita Falsiparum, Pengobatan