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Am. J. Trop. Med. Hyg., 70(2), 2004, pp. 125-127
Copyright © 2004 by The American Society of Tropical Medicine and Hygiene

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PLASMODIUM FALCIPARUM IN VIVO RESISTANCE TO QUININE: DESCRIPTION OF TWO RIII RESPONSES IN FRENCH GUIANA

MAGALIE DEMAR AND BERNARD CARME
Parasitology-Mycology Unit, Hospital of Cayenne/University of West Indies and French Guiana School of Medicine, Cayenne, French Guiana

The resistance of Plasmodium falciparum to antimalarial drugs is one of the most worrisome problems in tropical medicine, but few clinical studies or observations have described confirmed cases of therapeutic failure. We report two cases of in vivo P. falciparum resistance (RIII response) to quinine in French Guiana, an Amazonian focal zone in which multi-resistant malaria is endemic. Both patients presented with uncomplicated malaria and were initially treated with intravenous quinine. Although absorption was normal, the treatment was not effective and the patients still had fever and significant parasitemia three days after the onset of treatment (day 3). The addition of intravenous tetracycline completely resolved the parasitemia within approximately 96 hours. These clinical reports confirm the necessity to combine quinine with tetracycline in this area, as recommended by the recent French regional antimalarial policy.

Received May 15, 2003. Accepted for publication August 11, 2003.

Acknowledgments: We thank Dr. Keundjian (Institut de Médecine Tropicale du Service de Santé des Armées, Le Pharo, Marseille, France) for measuring the plasma concentrations of the antimalarial agents, and the Centre National de Référence sur la Chimiorésistance du Paludisme en Guyane Française (Pasteur Institute) for the carrying out the in vitro antimalarial assay.

Author’s address: Magalie Demar and Bernard Carme, Parasitology-Mycology Unit, Hospital of Cayenne/University of West Indies and French Guiana School of Medicine, EA 3593, BP 6006, F-97306 Cayenne, French Guiana, Telephone/Fax: 594-594-395309 or 594-594-287260, E-mail: b.carme{at}nplus.gf.




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Copyright © 2004 by the American Society of Tropical Medicine and Hygiene.