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  • Title: Chemotherapy of malaria.
    Author: Ponnampalam JT.
    Journal: Ann Acad Med Singap; 1981 Jan; 10(1):99-106. PubMed ID: 7025744.
    Abstract:
    The chemotherapy of malaria is incomplete without taking into consideration the widespread presence of chloroquine resistant falciparum malaria necessitating the use of a combination of antimalarials in order to effect a radical cure. Fortunately, there has been no evidence of chloroquine resistance thus far with P vivax and P malariae. Chloroquine resistant falciparum strains are present in about 85% of patients suffering from falciparum malaria but fortunately over 90 percent of the resistant cases only show a mild degree of resistance of the RI (delayed) type which in the majority of cases responds to larger doses of chloroquine over and above the amount administered in the standard three days regime. A combination of antimalarials is necessary in order to effect a radical cure in chloroquine resistant falciparum malaria. Vivax malaria and malaria due to P malariae best respond to sequential therapy with chloroquine and primaquine. This review of the chemotherapy of malaria covers the following: history of malaria chemotherapy; the rationale of malaria chemotherapy (drug trials related to malariotherapy, drug trials utilizing human volunteers, drug trials on hospital patients, field trials, extended field trials, and mass drug administration); the malaria situation in Southeast Asia; drug resistant malaria; the clinical features of malaria; diagnosis and treatment; and chemoprophylaxis. There is no single all purpose drug that is suitable for the treatment and prevention of malaria. Single dose treatment is the method of choice. An urgent need exists for a schizonticidal drug that would remain effective in the body for 3-6 months after a single dose, such a drug should be effective against both trophozoites and gametocytes. Rather than the present 14-day course of primaquine to eradicate exo-erythrocytic forms, a drug which is effective after a 3-day course is urgently required. Malaria continues to be a major public health problem in most of the countries of Southeast Asia. Prevalence of species of malaria parasites show wide variation from country to country, but Plasmodium falciparum is more prevalent than either P. vivax or P. malariae. Drug resistant malaria presents an added problem in Southeast Asia with P. falciparum showing resistance to chloroquine and to other antimalarials. The degree of resistance varies from country to country. Documented cases of resistance have been reported from all the countries of the region, and dosage schedules of various antimalarials have to be modified and combination of drugs used when treating such cases. All that is needed to make a laboratory diagnosis of malaria is a microscope, a few slides, and Field's stain. In view of the high incidence of chloroquine resistant falciparum malaria in the countries of the Southeast Asia region it is recommended that severe forms of falciparum infections be treated in the hospital for the 1st week. About 15% of patients still respond to the standard dose of chloroquine and remain parasite free for 28 days, i.e., the strain of P. falciparum is said to be sensitive to chloroquine. Over 90% of the resistant cases only show a mild degree of resistance of the RI (delayed) type which in the majority of cases responds to larger doses of chloroquine over and above the amount administered in the standard 3 day regimen. A combination of antimalarials is required to effect a radical cure in chloroquine resistant falciparum malaria. Vivax malaria and malaria due to P. malariae best respond to sequential therapy with chloroquine and primaquine.
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