in vitro assement of drug resistance in p. f in 5 states of india..
i have only this information but its 2012 paper if any one have latest pls inform me or help me .. ?
Thanks
with regards
Pls see at the site of NVBDC ......or go to the malaria site ... theie must me some record or you can see the WHO guidelines ... for..... in vitro- drug sensitivity .......
I do not have a specific answer to your question about drug resistance in India, but would like to point out some of the generic issues in defining "drug resistance" as apposed to "treatment failure". The current drug susceptibility protocols report the EC50 growth inhibitory values and only rarely the Hill slope of the growth inhibition curve (the EC90 or ECanything can be determined knowing both EC50 and Hill slope). This is important because it is possible to have a resistant cell line with an EC50 that is more susceptible at this concentration, but less susceptible at therapeutically relevant drug concentrations (i.e. EC90 or EC99) due to a low Hill slope.
The attached publication in Nature Microbiology (Fairlamb et al 2016 Drug resistance in eukaryotic microorganisms Nat Microbiol. 2016 Jun 24;1(7):16092. doi: 10.1038/nmicrobiol.2016.92. Review) covers this in more detail. If you want a reprint please send me a request to [email protected]).
Good luck!
Alan Fairlamb
Dear Richa,
Your question should be reformulated. For what purpose do you need cut off values that do not exist for most antimalarial drugs? In vitro tests should be compared on the basis of the same protocoles, and there is clearly no portability of values from these tests. Cut off should be validated by therapeutic failures, as mentionned by Alan. This is mostly lacking. And in vivo efficiency is multifactorial (depends on drug, on immunity, on transmission...). The good question is to compared data obtained from a similar test in the same area during the same season, and to look for a drift.
Best
Stephane Picot
From the malarial control programme point of view:
One should attend your question as something to be carefully looked at on regional case by case basis.
However from Global Malaria Programme (GMP) of the WHO point of view if your reference antimalarial being referred here are: Artemisinin and artemisinin-based combination therapy (ACT) then the resistance at programme level is considered:
When the malaria control programmes’ adopted antimalarial medicines with a parasitological cure rate of more than 95% start showing some level of parasite failure cure rate below 95% but still greater than 90%.
A change in the national malaria treatment policy should be considered if the total treatment failure proportion cut off is ≥ 10%, as assessed through in vivo monitoring of therapeutic efficacy (in established sentinel sites at least once in 24 months).
More notes on this question can be accessed from the recent GMP report on ACT resistance (October 2016) available at: http://apps.who.int/iris/bitstream/10665/250294/1/WHO-HTM-GMP-2016.11-eng.pdf?ua=1
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