Volume 77, Issue 6_Suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Reduced sensitivity of to formerly recommended cheap and well-known antimalarial drugs places an increasing burden on malaria control programs and national health systems in endemic countries. The high costs of the new artemisinin-based combination treatments underline the use of rational and updated malaria treatment policies, but defining and updating such policies requires a sufficient volume of high-quality drug-resistance data collected at national and regional levels. Three main tools are used for drug resistance monitoring, including therapeutic efficacy tests, in vitro tests, and analyses of molecular markers. Data obtained with the therapeutic efficacy test conducted according to the standard protocol of the World Health Organization are most useful for updating national treatment policies, while the in vitro test and molecular markers can provide important additional information about changing patterns of resistance. However, some of the tests are technically demanding, and thus there is a need for more resources for training and capacity building in endemic countries to be able to adequately respond to the challenge of drug resistance.


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  1. World Health Organization, 2005a. World malaria report. Geneva: World Health Organization. WHO/HTM/MAL/2005.1102.
  2. World Health Organization, 2005b. Guidelines for the treatment of malaria. Geneva: World Health Organization. WHO/HTM/ MAL/2006.1108.
  3. Bruce-Chwatt LJ, Black RH, Canfield CJ, Clyde DF, Peters W, Wernsdorfer WH, 1986. Chemotherapy of malaria, revised 2nd ed. World Health Organization: Geneva.
  4. White NJ, 1998. Why is it that antimalarial drug treatments do not always work? Ann Trop Med Parasitol 92 : 449–458. [Google Scholar]
  5. World Health Organization, 2005. Susceptibility of Plasmodium falciparum to antimalarial drugs. Report on global monitoring 1996–2004. Geneva: World Health Organization. WHO/HTM/ MAL/2006.1108.
  6. Baird JK, 2004. Chloroquine resistance in Plasmodium vivax. Antimicrob Agents Chemother 48 : 4075–4083. [Google Scholar]
  7. Maguire JD, Sumawinata IW, Masbar S, Laksana B, Prodjodipuro P, Susanti I, Sismadi P, Mahmud N, Bangs MJ, Baird JK, 2002. Chloroquine-resistant Plasmodium malariae in south Sumatra, Indonesia. Lancet 360 : 58–60. [Google Scholar]
  8. Imwong M, Pukrittakayamee S, Looareesuwan S, Pasvol G, Poirreiz J, White NJ, Snounou G, 2001. Association of genetic mutations in Plasmodium vivax dhfr with resistance to sulfadoxine–pyrimethamine: geographical and clinical correlates. Antimicrob Agents Chemother 45 : 3122–3127. [Google Scholar]
  9. Korsinczky M, Fischer K, Chen N, Baker J, Rieckmann K, Cheng Q, 2004. Sulfadoxine resistance in Plasmodium vivax is associated with a specific amino acid in dihydropteroate synthase at the putative sulfadoxine-binding site. Antimicrob Agents Chemother 48 : 2214–2222. [Google Scholar]
  10. World Health Organization, 2003. Assessment and monitoring of antimalarial drug efficacy for the treatment of uncomplicated falciparum malaria. Geneva: World Health Organization. WHO/HTM/RBM/2003.50.
  11. East African Network for Monitoring Antimalarial Treatment (EANMAT), 2003. The efficacy of antimalarial monotherapies, sulphadoxine–pyrimethamine and amodiaquine in East Africa: implications for sub-regional policy. Trop Med Int Health 8 : 860–867. [Google Scholar]
  12. World Health Organization, 1996. Assessment of therapeutic efficacy of antimalarial drugs for uncomplicated falciparum malaria in areas with intense transmission. Geneva: World Health Organization. WHO/MAL/96.1077.
  13. Baird JK, Leksana B, Masbar S, Fryauff DJ, Sutanihardja MA, Suradi, Wignall FS, Hoffman SL, 1997. Diagnosis of resistance to chloroquine by Plasmodium vivax: timing of recurrence and whole blood chloroquine levels. Am J Trop Med Hyg 56 : 621–626. [Google Scholar]
  14. Noedl H, Wongsrichanalai C, Wernsdorfer WH, 2003. Malaria drug-sensitivity testing: new assays, new perspectives. Trends Parasitol 19 : 175–181. [Google Scholar]
  15. Wernsdorfer WH, Noedl H, 2003. Molecular markers for drug resistance in malaria: use in treatment, diagnosis and epidemiology. Curr Opin Infect Dis 16 : 553–558. [Google Scholar]
  16. Price RN, Uhlemann AC, Brockman A, McGready R, Ashley E, Phaipun L, Patel R, Laing K, Looareesuwan S, White NJ, Nosten F, Krishna S, 2004. Mefloquine resistance in Plasmodium falciparum and increased pfmdr1 gene copy number. Lancet 364 : 438–447. [Google Scholar]
  17. Duraisingh MT, von Seidlein LV, Jepson A, Jones P, Sambou I, Pinder M, Warhurst DC, 2000. The tyrosine-86 allele of the pfmdr1 gene of Plasmodium falciparum is associated with increased sensitivity to the anti-malarials mefloquine and arte-misinin. Mol Biochem Parasitol 108 : 13–23. [Google Scholar]
  18. Gil JP, Nogueira F, Stromberg-Norklit J, Lindberg J, Carrolo M, Casimiro C, Lopes D, Arez AP, Cravo PV, Rosario VE, 2003. Detection of atovaquone and malarone resistance conferring mutations in Plasmodium falciparum cytochrome b gene (cytb). Mol Cell Probes 17 : 85–89. [Google Scholar]
  19. Wichmann O, Muehlen M, Gruss H, Mockenhaupt FP, Suttorp N, Jelinek T, 2004. Malarone treatment failure not associated with previously described mutations in the cytochrome b gene. Malar J 3 : 14. [Google Scholar]
  20. Alifrangis M, Enosse S, Pearce R, Drakeley C, Roper C, Khalil IF, Nkya WM, Ronn AM, Theander TG, Bygbjerg IC, 2005. A simple, high-throughput method to detect Plasmodium falciparum single nucleotide polymorphisms in the dihydrofolate reductase, dihydropteroate synthase, and P. falciparum chloroquine resistance transporter genes using polymerase chain reaction- and enzyme-linked immunosorbent assay-based technology. Am J Trop Med Hyg 72 : 155–162. [Google Scholar]
  21. Pearce RJ, Drakeley C, Chandramohan D, Mosha F, Roper C, 2003. Molecular determination of point mutation haplotypes in the dihydrofolate reductase and dihydropteroate synthase of Plasmodium falciparum in three districts of northern Tanzania. Antimicrob Agents Chemother 47 : 1347–1354. [Google Scholar]
  22. Roper C, Pearce R, Bredenkamp B, Gumede J, Drakeley C, Mosha F, Chandramohan D, Sharp B, 2003. Antifolate anti-malarial resistance in southeast Africa: a population-based analysis. Lancet 361 : 1174–1181. [Google Scholar]
  23. Snounou G, Beck HP, 1998. The use of PCR genotyping in the assessment of recrudescence or reinfection after antimalarial drug treatment. Parasitol Today 14 : 462–467. [Google Scholar]
  24. East African Network for Monitoring Antimalarial Treatment (EANMAT), 2001. Monitoring antimalarial drug resistance within national malaria control programmes: the EANMAT experience. Trop Med Int Health 6 : 891–898. [Google Scholar]
  25. Kitua AY, 1999. Antimalarial drug policy: making systematic change. Lancet 354 (Suppl): SIV32. [Google Scholar]
  26. World Health Organization, 2001. Antimalarial drug combination therapy. Report of a WHO technical consultation. Geneva: World Health Organization. WHO/CDS/RBM/2001.35.
  27. Djimdé AA, Dolo A, Ouattara A, Diakite S, Plowe CV, Doumbo OK, 2004. Molecular diagnosis of resistance to antimalarial drugs during epidemics and in war zones. J Infect Dis 190 : 853–855. [Google Scholar]
  28. Yang H, Liu D, Yang Y, Fan B, Yang P, Li X, Li C, Dong Y, Yang C, 2003. Changes in susceptibility of Plasmodium falciparum to artesunate in vitro in Yunnan Province, China. Trans R Soc Trop Med Hyg 97 : 226–228. [Google Scholar]
  29. Mita T, Kaneko A, Lum JK, Bwijo B, Takechi M, Zungu IL, Tsukahara T, Tanabe K, Kobayakawa T, Bjorkman A, 2003. Recovery of chloroquine sensitivity and low prevalence of the Plasmodium falciparum chloroquine resistance transporter gene mutation K76T following the discontinuance of chloroquine use in Malawi. Am J Trop Med Hyg 68 : 413–415. [Google Scholar]

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  • Received : 21 Aug 2006
  • Accepted : 05 Jan 2007

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