Drug-Resistant Malaria - libdoc.who.int - World Health Organization

66 / CONTROL
The list is not very impressive, especially when one views
the levels of resi st ance that exist to proguanil, pyrimethamine
and chloroquine, and the geographical spread of P.falciparum
resistant to one or more of these compounds. Resistance to
Fansidar is being recognized increasingly in such countries as
Thailand and Brazil. The response to amodiaquine is not
sufficiently superior to the response to chloroquine to make it a
ser~ous contender as a replacement for the latter. While quinine
retains its place as the drug of choice for the treatment of
serious falciparum malaria, especially where mUltiple drug
resistance is present, a number of falciparum infections have
recently been noted not to respond as readily to this drug as
would be expected, and it seems likely that some degree of quinine
resistance is beginning to emerge, at least ~n parts of the
Indochinese peninsula.
Recommendations for the deployment of currently available
drugs are summarized ~n Table 9.
Mef loquine is not yet avai lab le , al though advanced c Hnical
trials current ly under way should permit the release of limited
supplies of this new drug for therapy under controlled conditions
in the near future. There is a serious danger however, that the
potentially valuable clinical life of mefloquine will be foreshortened
if it is freed for unrestricted use alone, and measures
are being sought to protect it by using it in combination with
other drugs. These studies still require several years for their
completion (see Annex 11). In the meantime the use of mefloquine
alone should be rigorously restricted to indications where there
is no ethically acceptable alternative.
Possible Measures to Combat Drug Resistance
Prevention or Delay of the Emergence of Resistance
(a) Limiting the use of drugs
The major obstac le to limiting the use of antimalarial drugs
is their ready availability on the open market. It is probably a
council of perfection to suggest that antimalarial drugs should
only be imported and supplied through national health authorities.
The least that should be aimed for is government control
of the distribution and/or sale of antimalarials in affected
countries, even if laws exist for this purpose. While it ~s
certainly too late to do much to manage the use of existing
antimalarial drugs, every effort should be made to restrict the
importation and distribution of any new compound that becomes
available. If this is not done, new compounds will certainly meet
the same fate as the older ones, and in a short time they will be
rendered more or less obsolete by the emergence of malaria
parasites that are resistant to them. The current fate of