Volume 70, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The resistance of 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 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.


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  1. Segurado AA, Di Santi SM, Shiroma M, 1997. In vivo and in vitro Plasmodium falciparum resistance to chloroquine, amodiaquine and quinine in the Brazilian Amazon. Rev Inst Med Trop Sao Paulo 39 : 85–90.
  2. Boulos M, Dutra AP, Di Santi SM, Shiroma M, Amato Neto V, 1997. The clinical evaluation of quinine for the treatment of Plasmodium falciparum malaria. Rev Soc Bras Med Trop 30 : 211–213.
  3. Carme B, Venturin C, 1999. Le paludisme dans les Amériques. Tendances 1970–1998. Med Trop (Mars) 59 : 298–302.
  4. Pan American Health Organization, 1997. Malaria in the Americas. Epidemiol Bull 18 : 1–8.
  5. Reynes JM, Fargette J, Gaborit P, Yarde S, 1997. In vitro responses of Plasmodium falciparum isolates to five antimalaria drugs in French Guiana during 1994 and 1995. Mem Inst Oswaldo Cruz 92 : 251–252.
  6. Wongsrichanalai C, Pickard AL, Wernsdorfer WH, Meshnick SR, 2002. Epidemiology of drug-resistant malaria. Lancet Infect Dis 2 : 209–218.
  7. Peters W, 1987. Resistance of Human Malaria I, III and IV. Chemotherapy and Drug Resistance in Malaria. Second edition. London: Academic Press, 543–568, 593–658, 659–786.
  8. Bjorkman A, Phillips-Howard PA, 1990. The epidemiology of drug resistant malaria. Trans R Soc Trop Med Hyg 84 : 177–180.
  9. Cerutti Junior C, Marques C, Alencar FE, Durlacher R, Alween A, Segurado AA, Pang LW, Zalis MG, 1999. Antimalarial drug susceptibility testing of Plasmodium falciparum in Brazil using a radioisotope method. Mem Inst Oswaldo Cruz 94 : 803–809.
  10. Couto AA, Calvosa VS, Santos MA, Souza JM, 1995. The evolution over time of the in-vitro resistance of Plasmodium falciparum to antimalarial drugs in 2 areas of the Brazilian Amazonia with distinct socioeconomic and geographic characteristics. Rev Soc Bras Med Trop 28 : 357–365.
  11. Couto AA, Calvosa VS, Lima JE, Souza JM, 1993. The evolution of in-vitro resistance in Plasmodium falciparum to antimalarials in a gold-prospecting area in the state of Amapa between 1983 and 1990. Rev Soc Bras Med Trop 26 : 215–220.
  12. Couto AA, Calvosa VS, Santos MA, Souza JM, 1993. In vitro resistance of Plasmodium falciparum strains isolated in the south of the Para state, in different periods: occurrence of cases of multiple resistance. Rev Soc Bras Med Trop 26 : 5–9.
  13. Zalis MG, Pang L, Silveira MS, Milhous WK, Wirth DF, 1998. Characterization of Plasmodium falciparum isolated from the Amazon region of Brazil: evidence for quinine resistance. Am J Trop Med Hyg 58 : 630–637.
  14. Pinelli LL, Schoepfer ACA, Jardim DV, Santos ER, Almeida Neto JC, 1999. Plasmodium falciparum malaria. Quadrennial analysis, during 12 years, of the efficacy of quinine treatment. Rev Soc Bras Med Trop 32 : 241–245
  15. World Health Organization, 1973. Chemotherapy of malaria and resistance to antimalarials: report of a WHO scientific group. World Health Organ Tech Rep Ser 529 : 30–35.
  16. World Health Organization, 2001. The Use of Antimalarial Drugs. Report of an Informal Consultation. November 13–17, 2001. Geneva: World Health Organization. WHO/CDS/RBM/2001.

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  • Received : 15 May 2003
  • Accepted : 11 Aug 2003

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