Therapeutic failure with chloroquine in Plasmodium falciparum infections; possibility of high grade resistance
Wijesundera, M.D.; Seneviratne, J.K.; Illangasekera, V.L.; Ranaweera, R.L.; Dharmasena, B.D.
Ceylon Medical Journal 34(2): 77-85
1989
ISSN/ISBN: 0009-0875 PMID: 2695259 Document Number: 332031
Three case reports of falciparum malaria not responding to standard chloroquine therapy and necessitating the use of alternative antimalarial drugs for clinical improvement, are documented. In vitro drug sensitivity tests and chloroquine assays were not carried out to conclusively exclude drug failure. However, the clinical course and the persistence of parasitaemia on thick blood film monitoring were suggestive of high grade chloroquine resistance. Such patients require clinical vigilance and the timely use of alternative antimalarials. When rapid clearance of parasitaemia is required quinine is the drug of choice. In malarial chemotherapy it is mandatory that strict therapeutic criteria be followed, to safeguard the efficacy of choloroquine as well as to prevent abuse of alternative drugs. In this context, the availability of thick blood films and in vitro drug sensitivity testing facilities in hospitals would be useful to clinicians.