From the 1940s-1990s, chloroquine was the mainstay of malaria therapy worldwide. Selection of P.falciparum-resistant isolates was first reported in Southeast Asia (Thai-Cambodian border) and South America (Colombia) in the 1950s. Since then chloroquine resistance has spread far beyond the first focus and is now found in all parts of the world where malaria is endemic. Chloroquine resistance has emerged independently less than ten times in the past 50 years. Can chloroquine be used in antimalarial treatment at present status both in children and adult populations?
I'm layman but observe the scene.
Probably the most fitting article is
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014064
More:
http://www.augos.com/temp/Temp_chloroquine1.html
http://www.augos.com/temp/Temp_chloroquine2.html
Regards,
Joachim
Dear Joachim Primiskern, Thanks for your observation, I wish to share you that I am writing on this conept of Chloroquine resistance malaria shortly going to publish focusing on the chloroquine resistance to the emerging resistance of the arthesemesin combinations. The global burden of the malaria is still on the leading cause of deaths in tropical and africa regions. Recently, India got the First Patent of a Fully synthasized Antimalarial drug arterolane maleate 150 mg and piperaquine phosphate 750 mg drug showing satisfactory results in adult population. But still the chioroquine is a first line in pediatric population.
Chloroquine-Resistance Malaria
Malaria is the major health problem in developing countries including India. Resistance to antimalarial drugs is proving to be a challenging problem in malaria control in most parts of the world. Chloroquine resistance has emerged independently less than ten times in the past 50 years and the most of the chloroquine resistance targets are localized in the acid food vacuole of the malaria. Resistance to P.falciparum may be due to increased capacity of the parasite to expel chloroquine to reach levels required for inhibition of the heme-polymerization. Resistance to sufadoxime-pyrimethamine, quinine and mefloquine is much higher than the chloroquine. Increased chloroquine treatment failure has led to change the drug policy to artesunate combined therapy (ACT) as first line of malaria treatment. The artesunate-based combination currently used in the established multidrug-resistant areas on different parts of world. With emerging resistance there is a urgent need of a fully synthetic drug such as arterolane, which has an activity profile that is similar to that of the artemisinins, provides an important potential in such an endeavor.
http://www.sciensage.info/journal/1345729031JASR_1007121.pdf
Chloroquine resistance occurs mostly in P.falciparum ( Pf ) , but P. vivax ( Pv ) responds to Chloroquine . The following policy has been adopted in India - 1) Uncomplicated P. vivax malaria : Chloroquine is the drug of choice & Primaquine for radical cure. 2) Uncomplicated P.falciparum malaria : Artemisinin Combination Treatment ( ACT ). 3) Complicated Pf / Pv : IV Artesunate / Quinine & Doxycycline / Clindamycin combination . Primaquine is used in a single dose for gametocidal activity against Pf . In India , 50% of malaria is due to Pv & the other 50% is due to Pf . In India , the dramatic rise in Pf is due to resistance to Chloroquine , but the decline in Pv is also due to Chloroquine . There are some reports of Chloroquine resistance in N.E. India .
The major problem is non-availability of diagnostic tests in rural areas . Diagnosis by peripheral smear is the gold standard , but requires skilled technicians to do the test . Rapid tests for Pv / Pf have become available , but sensitivity & specificity has to be evaluated . Therefore , the policy has been that in a patient with fever suspected to be due to malaria & diagnostic tests are not available , the drug of choice is Chloroquine . If rapid tests are positive for Pf , then ACT should be used . This policy is to avoid indiscriminate use of ACT , as this may lead to drug resistance . Hence , Chloroquine still plays an important role in the management of Pv .
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