Antimalarial Asia, and parts of Africa. Resistance

Antimalarial drug resistance is now generally approved
to be one of the considerable risk to our ability to ‘Roll back malaria’. The situation
is getting worse; with the growing frequency and rising drug resistance (Yeung et
al., 2004). Chloroquin resistant plasmodium falciparum malaria now
prevail in South America, Southeast Asia, and parts of Africa. Resistance to
sulphadoxine-pyrimethamine is common in South America, Asia and and is spred
out in Africa and even quinine has become less efficient over time (Yeung et
al., 2004). Conditions are not different in Pakistan and
falciparum malaria is on the progress (Nizamani et al., 2006). In
a moment  falciparum malaria accounts for
18% to 62% of all cases of malaria in different zones of Pakistan with
resistance to one or more antimalarials reaching up to 40% (Khan et al., 2004). Resistance of falciparum malaria to chloroquin
is broadly expand in Pakistan and it is no longer supported (Shah et
al., 1997; Rana et al., 2004).
Quinine is the drug of choice for P. falciparum but irregular cases of
resistant strains are being recorded with monotherapy (Jamal et
al., 2005;Bhalli et al., 2001;). Artimisinin
derivatives are currently useful but are expensive for a developing country to
be used on a mass scale (Laxminarayan
et al., 2004). Recently
use of antimalarials in combination with other antibiotics has been promoted in
many countries (Khan
et al., 2004). The
target are twofold: to manage synergistic or additive killing of parasites, and
to prevent development of drug resistance. Quinine has been used in combination
with , azithromycin, doxycycline, clindamycin (Alecrim et al., 2006 ; Miller et al., 2006). All have been recorded to be efficient. There
is insufficiency of description in Pakistani medical literature representing
the use of quinine based combination therapy. However it has been recommended
in the guidelines of treatment of falciparum malaria (Khan
et al., 2004).