title: Therapeutic failure with chloroquine in Plasmodium falciparum infections; possibility of high grade resistance.
abstract: Three case reports of falciparum malaria not responding to standard chloroquine therapy and necessitating the use of alternative antimalarial drugs for clinical improvement, are documented. In vitro drug sensitivity tests and chloroquine assays were not carried out to conclusively exclude drug failure. However, the clinical course and the persistence of parasitaemia on thick blood film monitoring were suggestive of high grade chloroquine resistance. Such patients require clinical vigilance and the timely use of alternative antimalarials. When rapid clearance of parasitaemia is required quinine is the drug of choice. In malarial chemotherapy it is mandatory that strict therapeutic criteria be followed, to safeguard the efficacy of chloroquine as well as to prevent abuse of alternative drugs. In this context, the availability of thick blood films and in vitro drug sensitivity testing facilities in hospitals would be useful to clinicians.
authors.forename: M D
authors.initials: MD
authors.lastname: Wijesundera
authors.forename: J K
authors.initials: JK
authors.lastname: Seneviratne
authors.forename: V L
authors.initials: VL
authors.lastname: Illangasekera
authors.forename: R L
authors.initials: RL
authors.lastname: Ranaweera
authors.forename: B D
authors.initials: BD
authors.lastname: Dharmasena
mesh_terms: D000328:Adult; D000818:Animals; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects
chemical_list: D002738:Chloroquine