in-vitro and molecular studies on the resistance of p - Covenant ...

2.5.5Serology………………………………………………………………….19
2.6 Antimalarial Drugs…………………………………………………………….19
2.6.1 Qu<strong>in</strong><strong>in</strong>e <strong>and</strong> related compounds……………………………………….19
2.6.2 Antifolate drugs………………………………………………………..23
2.6.3 Antibiotics……………………………………………………………..25
2.6.4 Artemis<strong>in</strong><strong>in</strong> compounds……………………………………………….26
2.7 Comb<strong>in</strong>ation therapy with antimalarials………………………………………28
2.7.1 Non-Artemis<strong>in</strong><strong>in</strong> based comb<strong>in</strong>ations…………………………………29
2.7.2 Artemis<strong>in</strong><strong>in</strong>-based comb<strong>in</strong>ations………………………………………29
2.7.3 Traditional Antimalarial Herbs………………………………………...31
2.8 Antimalarial Drug Resistance …………………………………………………33
2.8.1 Def<strong>in</strong>ition of antimalarial drug resistance……………………………..34
2.8.2 Malaria treatment failure………………………………………………34
2.8.3 Mechanisms of antimalarial resistance………………………………..35
2.8.3.1 Chloroqu<strong>in</strong>e resistance………………………………………………...35
2.8.3.2 Antifolate comb<strong>in</strong>ation drugs………………………………………….36
2.9 Spread of resistance…………………………………………………………....36
2.9.1 Biological <strong>in</strong>fluences on resistance…………………………………....37
2.9.2 Programmatic <strong>in</strong>fluences on resistance………………………………..40
2.10 Detection of resistance………………………………………………………...42
2.10.1 In vivo tests…………………………………………………………....42
2.10.2 In <strong>vitro</strong> tests…………………………………………………………...43
2.10.3 Animal model <strong>studies</strong>………………………………………………...45
2.10.4 Molecular techniques…………………………………………………45
2.10.5 Case reports <strong>and</strong> passive detection of treatment failure………………46
2.11 The future: prevention of drug resistance…………………………………….46
CHAPTER THREE – MATERIALS AND METHODS
3.1 Study Area…………………………………………………………………..49
3.2 Study Patients………………………………………………………………..49
3.3 Sampl<strong>in</strong>g Procedure………………………………………………………….49
3.4 Ethical Consideration………………………………………………………...51
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