Chloroquine-resistant Plasmodium falciparum: now in Pakistani Punjab

To investigate the susceptibility of Plasmodium falciparum to chloroquine in Pakistani Punjab, in-vivo and in-vitro drug susceptibility was tested in 3 villages. Of 66 patients followed for up to 14 days after chloroquine treatment, 53 (80%) had parasites sensitive to chloroquine, 10 (15%) had parasites with early RI resistance, and 3 (5%) had parasites with RII resistance. Of 42 falciparum isolates investigated in vitro, 12 were sensitive, 8 intermediate, and 22 resistant to chloroquine. The degree of in-vivo resistance correlated with the degree of in-vitro resistance. It is concluded that chloroquine resistance is common among falciparum parasites in Pakistan and that this chloroquine resistance could explain the recent increase in the prevalence of falciparum malaria in the Punjab. Alternative antimalarials should therefore be investigated for both treatment and chemoprophylaxis against falciparum parasites in Pakistan.