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Ovid: Oxford Handbook of Tropical Medicine

Editors: Eddleston, Michael; Pierini, Stephen; Wilkinson, Robert; Davidson, Robert Title: Oxford Handbook of Tropical Medicine, 2nd Edition Copyright ©2005 Oxford University Press (Copyright 2005 by M. Eddleston, S. Pierini, R. Wilkinson, and R. Davidson) > Table of Contents > Chapter 2 > Chapter 2A – Malaria > Multidrug-resistant malaria and treatment failure Multidrug-resistant malaria and treatment failure Resistance of malarial parasites to conventional drugs is a growing problem across the world (see Fig. 2A.7), particularly with P. falciparum. In certain areas, notably in South-East Asia, prophylaxis with chloroquine or pyrimethamine-sulfadoxine, and treatment with mefloquine or pyrimethamine-sulfadoxine are no longer recommended. P. vivax resistance has been reported in areas of South-East Asia. Chloroquine resistance is classified as follows:

  • R1: recrudescence occurs <4 wks after apparently successful treatment.
  • R2: despite improvement with treatment, parasitaemia persists and increases soon afterwards, heralding a clinical deterioration in the patient.
  • R3: complete resistance in which the patient continues to deteriorate (and the parasitaemia increases) despite treatment, until chloroquine is replaced by an effective drug.

Treatment failure is defined as a failure of either symptoms to begin to improve or the parasite count to have fallen by 75% within 48 hrs. It is possible with any drug and may result from:

  • Inadequate treatment (patient non-compliance or oral drug vomited)
  • Parasite resistance to drug
  • Poor drug quality
  • Non-malarial cause for the symptoms.

Reassess the patient and if malaria is still thought to be the cause, change to a different treatment and ensure that the patient is compliant with therapy.

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