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INTRODUCTION | DEFINITION | METHODS OF TESTING (I) | METHODS OF TESTING (II)
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D R U G R E S I S T A N C E I N M A L A R I A
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INTRODUCTION
Despite considerable efforts to eradicate malaria in the last century, it still remains one of the most prevalent and the most devastating diseases in the tropics (WHO, 1993). Over time the emphasis changed from eradication to malaria control. In spite of the promising early results of malaria control in many countries affected, using chloroquine and insecticides, the incidence of malaria increased in many countries due a great extent to the development and spread of resistant strains of Plasmodium falciparum to chloroquine and subsequently to other antimalarials (Wernsdorfer, 1994).
Ever since the discovery of the first cases of chloroquine resistance along the Thai-Cambodian border (Pailin, Cambodia) in the late 1950s, Southeast Asia has played an important role as a focus for the development of drug resistance of P. falciparum. Although the first cases of quinine resistance had been reported much earlier from South-America (Neiva, 1910; Nocht & Werner, 1910), the onset of chloroquine resistance marked the beginning of a new chapter in the history of malaria in Southeast Asia. In the early sixties the increasing chloroquine resistance lead to a significant increase in mortality (Thimasarn, 1999) and by 1973 chloroquine finally had to be replaced by the combination of sulphadoxine and pyrimethamine (SP) as first-line drug for the treatment of uncomplicated malaria in Thailand. This resulted in a short-lived decrease in the incidence of malaria and was accompanied by a characteristic reduction in the ratio of P. falciparum to P. vivax. In 1985, eventually SP was replaced by mefloquine. The rapid development of resistance to this new drug (Wongsrichanalai et al., 1992) lead to the introduction of artemisinin or qinghaosu (Malaria Division Thailand, 1997) as a combination drug in the mid 1990s. Since then artemisinin derivatives have become an integral part of the treatment of multidrug resistant isolates of P. falciparum in Southeast Asia and elsewhere.
H. Noedl 2002
http://malaria.farch.net
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© 2002 H. Noedl
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