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INTISARI

Latar belakang: Malaria masih menjadi masalah kesehatan di NTT khususnya di

Kabupaten Kupang. Kementrian Kesehatan Indonesia telah merekomendasikan
Artemisinin based combination therapies (ACTs) termasuk dihidroartemisinin
piperakuin (DHP), sebagai anti malaria di Kabupaten Kupang. Akan tetapi, pada
beberapa daerah di Indonesia, termasuk Kabupaten Kupang, klorokuin masih
digunakan sebagai anti malaria di beberapa pelayanan kesehatan teristimewa pada
daerah-daerah yang mengalami kesulitan dalam pendistribusian ACTs.
Tujuan: Mengetahui perbedaan efek terapi DHP dibandingkan dengan klorokuin.
Metode: Penelitian ini merupakan penelitian kuasi eksperimental. Total subjek 51
orang yakni 25 orang diterapi dengan DHP dan 26 orang diterapi dengan CQ. Pada
kedua kelompok dilakukan pengamatan klinis dan parasitologis selama 42 hari.
Respon klinis dinilai berdasarkan keadaan klinis, fever clearance time/FCT, gejala
yang muncul setelah minum obat dan munculnya kejadian malaria berat selama
pengamatan. Respon parasitologis dinilai berdasarkan kepadatan parasit, ada tidaknya
gametosit dan parasite clearance time/PCT. Respon terapi diklasifikasikan
berdasarkan protokol uji efikasi WHO 2009 dan dianalisis dengan menggunakan
metode Kaplan-Meier untuk memperoleh angka kesembuhan dan angka kegagalan
terapi masing-masing kelompok.
Hasil: Success cumulative incidence DHP sebesar 76 % (95% CI 0,542-0,884)
sedangkan CQ 57,7% (95% CI 0,368-73,9%). Failure cumulative incidence DHP
sebesar 24% (95% CI 0,116-0,458), sedangkan CQ 42,3% 95% CI (0,261-0,632).
Respon terapi CQ tidak berbeda bermakna dengan respon terapi DHP dengan RR
2,69 (95% CI 0,69-7,73) dan p= 0,166.
Kesimpulan: Efek terapi DHP lebih baik dibanding CQ meskipun secara statistik
tidak berbeda bermakna. Telah ditemukan angka kegagalan terapi lebih dari 10% dan
angka kesembuhan kurang dari 90% pada kelompok DHP maupun kelompok CQ.

Kata Kunci: dihidroartemisinin piperakuin, klorokuin, respon klinis dan

parasitologis
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ABSTRACT

Background: Malaria remains a health problem in NTT, especially in Kupang

district. Indonesian Ministry of Health has recommended Artemisinin based
combination therapy (ACTs) including dihidroartemisinin piperaquine (DHP), as an
antimalaria in Indonesia. However, in some areas in Indonesia, including Kupang
district, chloroquine is still used as an antimalarial in some health services especially
in areas that experience difficulties in the distribution of ACTs.
Objective: To compare the therapeutic effect of DHP with chloroquine.
Methods: This study was a quasi experimental study. Total subject was 51 people.
Twenty five subjects received DHP and 26 subjects received CQ. Clinical and
parasitological responses were observed in the two groups for 42 days. The clinical
response was evaluated by observing clinical condition, fever clearance time (FCT),
the emerging symptom after taking drugs and the emergence of acute malaria during
the observation. The parasitological response was evaluated by observing parasite
density, the presence of gametocyte and parasite clearance time (PCT). The
therapeutic responses were classified following the protocol efficacy test of WHO
2009 and analyzed using the Kaplan Meier method to obtain the cure rate and failure
rate of each group.
Results: Success cumulative incidence of the DHP group was 0.76 (95% CI 0.542-
0.884) and failure cumulative incidence was 0.24 (95% CI 0.116-0.458). The success
cumulative incidence of the CQ group was 0.577 (95% CI 0.368-0.739) and the
failure cumulative incidence was 0.423 (95% CI 0.261-0.632). There was not
significant difference between CQ therapy response and DHP therapy response, p =
0.166 with RR 2.69 (95% CI 0.69-7.73).
Conclusion: The therapeutic effect of DHP is better than CQ although statistically
not significant. It has been found therapeutic failure rate of over 10% and a cure rate
of less than 90 % in the DHP and CQ group.

Keywords: dihidroartemisinin piperaquine, chloroquine, clinical and parasitological

response.