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Drug
Resistance: Malaria
Anti-malarial drug
resistance is a major public health problem which hinders the control of
malaria. In India resistance of Plasmodium falciparum to choloroquine, the
cheapest and the most used drug was first reported in the year 1973 from
Diphu of Karbi-Anglong district in Assam state. The Dte. of National
Vector Borne Diseases Control Programme has been monitoring the efficacy
of antimalarial drug in Pf malaria parasite in the country since
1978 through 13 monitoring teams located in 11 Regional Office for Health
& Family Welfares with the following objectives:
Objectives
of monitoring antimalarial drug resistance
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Evaluate the efficacy of first- and second-line drugs used in the
treatment of malaria
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Provide information for action: provide good quality data to formulate
drug policies.
Tools
for monitoring
Till 2002 drug sensitivity status in the
country was assessed following conventional WHO In-vivo protocol. From
2002-03 onward new WHO protocol on “Therapeutic efficacy of
anti-malarial drugs in uncomplicated P.falciparum malaria” is being
followed to assess the efficacy of antimalarial drugs. The classification
of response to treatment according to new protocol is interpreted into
three categories as per the WHO criteria i.e Adequate Clinical and
Parasitological Response (ACPR), Early Treatment Failure (ETF) and Late
treatment Failure (LTF). Drug policy is changed for the Primary Health
Centres reporting 25% or more total treatment failure (ETF+LTF) to
chloroquine (first line of treatment) in a sample of minimum 30
P.falciparum test cases.
Status
of drug resistance in India
High
treatment failure to chloroquine has been detected in 241 PHCs of 57 districts in
19 states in the country and revised drug policy is being
followed in all these areas using second line of treatment as per the
NVBDCP malaria drug policy. List of areas and map depicting drug resistant
areas with revised drug policy enclosed.
Resistance to sulfa/pyrimethamine combination at various levels have been
reported from 12 Primary Health Centres in districts of seven states.
To
combat the drug resistant in malaria, the NVBDCP drug policy recommends
the use of combination therapy i.e Artesunate plus Sulfadoxine
Pyrimethamine as a second line of treatment for P.falcipuram cases
in chloroquine resistant areas.
States/Areas/PHCs with revised drug Policy for Malaria |
