Emerging drug--resistance and guidelines for treatment of malaria.
The increasing prevalence of multi-resistant Plasmodium falciparum malaria worldwide is a serious public health threat to the global control of malaria, especially in poor countries like Pakistan. In many countries choloroquine-resistance is a huge problem, accounting for more than 90% of malaria cases. In Pakistan, resistance to choloroquin is on the rise and reported in up to 16- 62% of Plasmodium falciparum. four to 25% of Plasmodium falciparum also reported to be resistant to sulfadoxine-pyrimethamine and several cases of delayed parasite clearance have been observed in patients with Plasmodium falciparum malaria treated with quinine. In this article we have introduced the concept of artemisinin- based combination therapy (ACT) and emphasize the use of empiric combination therapy for all patients with Plasmodium falciparum malaria to prevent development of drug resistance and to obtain additive and synergistic killing of parasite.
Khan
M Aslam
MA
Department of Medicine, The Aga Khan University Hospital, Karachi. mohammad.aslam@aku.edu
Smego
Raymond A
RA
Razi
Syed Tabish
ST
Beg
M Asim
MA
D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use*; D002738:Chloroquine; D004338:Drug Combinations; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D010154:Pakistan / Q000453:epidemiology; D010616:Phenanthrenes / Q000008:administration & dosage / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects*; D011802:Quinidine / Q000008:administration & dosage / Q000627:therapeutic use; D011803:Quinine / Q000008:administration & dosage / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D010616:Phenanthrenes; D012717:Sesquiterpenes; D002738:Chloroquine; C031327:artemisinin; D011803:Quinine; D011802:Quinidine; C023768:halofantrine