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

RECOMMENDATIONS / 87
DEVELOPMENT OF IN VIVO AND IN VITRO TESTS FOR MONITORING DRUG
RESISTANCE
(v) In vivo tests should be broadened and adapted to include
drugs other than 4-aminoquinolines, redefining, if necessary, the
levels of drug response S, RI, RII and RIll.
(vi) In vitro tests for chloroquine and other drugs should be
further developed and adapted for field use, and efforts should be
made for their early introduction into the monitoring programme;
(vii) In certain countries studies on the correlat ion of the
results of the in vitro microtechnique and the in vivo tests for
assessing the response of P .falciparum to chloroquine, mefloquine
and other antimalarials should be conducted and related to actual
serum (plasma) drug levels;
(viii) In respect of mefloquine, baseline ~n vitro
data should be obtained and, in any country where
becomes operational, the response of P.falciparum
continuously monitored in vitro and in vivo;
sensitivity
this drug
should be
(ix) The monitoring of the response of P.falciparum to
chloroquine and other antimalarials, in respect of the degree of
drug sensitivity and the distribution of drug resistance should be
continued and extended on a scientific basis.
EVALUATION AND DEVELOPMENT OF ANTIMALARIAL DRUGS l
(x) Efforts should be increased to provide new compounds,
including indigenous drugs and combinations of compounds, and to
determine optimal drug regimens, and their efficacy should be
evaluated in vivo and in vitro in areas of multiple drug resistance.
Particular attention should be paid to the provision of
drugs suitable for use at Primary Health Care (PHC) and community
levels •
. (xi) Attention should be paid to the continuing need for
experimental in vivo testing systems, for example Aotus and rodent
models, in addition to in vitro techniques.
(xii) Additional research should be undertaken by appropriate
institutes into the mode of action of currently available and new
antimalarials, as we 11 as into mechanisms of the deve lopment of
resistance to drugs by P.falciparum.
1 In view of the importance of the search for new drugs and the
more effective utilization of already available and new compounds,
these recommendat ions camp lete those made in Chapter VII of this
report.