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[Malaria and drug resistance]
1Academisch Medisch Centrum, afd. Inwendige Geneeskunde, Amsterdam.
Nederlands Tijdschrift Voor Geneeskunde
|January 20, 1996
Summary
Drug resistance in malaria is a growing concern, with varying effectiveness of treatments across regions. Artemisinin resistance has not been reported, but pharmaceutical interest in new antimalarials is low.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Parasitology
Context:
- Antimalarial drug resistance poses a significant global health challenge.
- Factors contributing to resistance include extensive drug use, parasite selection, cross-resistance, and host genetics.
- Plasmodium ovale and Plasmodium malariae remain sensitive to current antimalarials.
Purpose:
- To review the current landscape of antimalarial drug resistance.
- To identify geographical patterns and specific drug resistance profiles.
- To highlight concerns regarding the development of new antimalarial therapies.
Summary:
- Chloroquine resistance is prevalent in Plasmodium vivax strains from the Pacific and Plasmodium falciparum strains in Southeast Asia, the Amazon, and parts of Africa.
- Sulfadoxine-pyrimethamine efficacy is limited in Southeast Asia and the Amazon but remains useful in tropical Africa.
- Mefloquine resistance is primarily observed in Thailand, with cross-resistance noted for halofantrine. Quinine sensitivity is decreasing in Thailand, though it remains effective, especially with tetracycline or doxycycline. Artemisinin resistance has not been reported.
Impact:
- Understanding drug resistance patterns is crucial for effective malaria treatment and control strategies.
- The lack of pharmaceutical interest in developing new antimalarials is a critical concern given rising resistance.
- Intravenous quinine remains the standard for severe malaria, but emerging resistance necessitates ongoing research and development.