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The Health Implications Of The Drug Resistance Of P. Falciparium In Malaria Attack

Updated on March 31, 2014

Persistence Of Malaria Infection Due To Drug Resistance

Source

A General Overview

Plasmodium falciparum has developed resistance to the common suppressant drugs during the past two decades. In many areas, this has reached alarming proportions so as to render the standard antimalarial drugs virtually ineffective. When a parasite strain is able to survive, multiply, or both, even after the administration and absorption of adequate recommended therapeutic dose or a higher dose of an active schizontidical drug, it is considered resistant (WHO, 1967)

Classification Of Anti-Malarial Drugs

Name
Route
Remarks
Schizonticidal drugs
 
 
Chloroquine (4 amino quinolone group) diphosphate & Sulphate
150 mg base (1 tab); oral
Most effective schizonticidal drug, except in resistant P. falciparum. It shows cross-resistance (CR) with mepacrine
Chloroquine hydrochloride
200 mg; intramuscular or intravenous
Used for pernicious malaria
Amodiaquin (4 aminoquinolone group) (Camoquin)
200 mg tab; oral
Same as above
Mepacrine (4 acridine dye)
100 mg tab; oral
Powerful schizonticidal drug, rarely used now due to side effects; shows cross-resistance with chloriquine
Quinine (alkaloid)
260/325 mg tablets; oral
Schizonticide
Quinine sulphate
325 mg tablets; oral
Schizonticide
Quinine ethyl carbonate
Same as Sulphates; oral
For pernicious and resistant forms, less bitter, used for children.
Quinine dihydrochloride
500 to 650 mg; intravenous solution
For pernicious and resistant forms (quinine is not freely available at present)
Proguanil (Synthetic biguanide)
100 mg tablet; oral
It is a weak schizonticide effective in semi-immunes it is a good causal prophylactic and it inhibits sexual cycle in mosquito
Pyrimethamine
25 mg tablet; oral
Causal prophylaxis, inhibits sexual cycle in mosquito and shows cross resistance with proguanil
Sulfodoxine (long acting sulphonamide)
0.5 mg tablet; oral
Schizonticide used for resistant P. falciparum in combination with pyrimethamine (Fansidar, Croydoxin, Malocide). Pyrimethamine 25 mg + Sulfodoxine 0.5g
Mefloquine (a quinoline methanol)
0.5 mg tablet; oral
Schizonticide used for resistant P.falciparum in a single dose of 1500 mg.
Cotrimoxazole
Trimethoprim 80 mg + Sulphamethoxazole 400 mg tablets; oral
Schizonticide used for resistant P.falciparum
Tetracycline
250 mg capsules
Slowly acting schizonticide
Dapsone
100 mg tablets; oral
Weak schizonticide. If combined with 25 mg pyrimethamine, it is used for resistant P. falciparum pyrimethamine 25 mg + Dapsone 100 mg- Maloprim
Metakalfin
Sulphalene 500 mg + pyrimethamine 25 mg; oral
Effective in resistant P. falciparum
Drug used for eradication
 
 
Primaquine (8-aminoquinoline group)
2.5/7.5 mg tablets; oral
Effectively eradicates the exo-erythrocytic cycle, kills gametocytes, and weakly schizonticidal

Malaria Attack Treatment

Source

Treatment Of An Overt Attack

The drug of choice is chloroquine or amodiaquine, if the parasites are sensitive. The initial dose of 600 mg of the base (4 tablets) is given orally. It is followed six hours later by 300 mg (2 tabs) and then 150 mg (1 tab) twice a day for 3 to 7 days. For children, the initial dose is 5 to 10 mg/Kg body weight. Semi-immunes may respond to a single dose of 600 mg. Troublesome side effects include allergy, gastritis, dermatitis, psychosis, convulsions, photosensitization and deposition of the drug in the cornea and retina. When the drug is withdrawn, the corneal deposits clear up, but the retinal deposites set up adverse reactions which lead to visual loss. Therefore, ocular toxicity is an absolute contraindication to further chloroquine therapy. Alternative drugs are:

  1. Amodiaquine in a dose of 600 mg on the first day and then 400 mg daily for two more days;
  2. Quinine sulphate, 650 mg twice a day for 10 days; or
  3. Mepacrine 300 mg thrice on the first day, 200 mg thrice on the second day and 100 mg thrice a day for five days.

Adverse effects of quinine are gastrointestinal irritation, allergy, amblyopia, optic neuritis, myocarditis (especially, if given intravenously), deafness due to VIII cranial nerve damage and precipitation of black water fever. Mepacrine is seldom used at present due to toxicity. Toxicity includes psychosis, yellow staining of the skin, hair and nails, lichen planus, allergy and granulocytopenia.

© 2014 Funom Theophilus Makama

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    • married2medicine profile imageAUTHOR

      Funom Theophilus Makama 

      4 years ago from Europe

      Thanks a lot Eddy

    • Eiddwen profile image

      Eiddwen 

      4 years ago from Wales

      Another very interesting hub and voting up for sure. Enjoy your day.

      Eddy.

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