Drug resistance

Drug resistance in malaria. Peter B. Bloland

WHO/CDS/CSR/DRS/2001/4

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Drug resistance in malaria. Peter B. Bloland

1. Introduction

2. Disease incidence and trends
2.1 Geographical distribution and populations at risk
2.2 Causative agents
2.3 Diagnosis
2.3.1 Microscopy
2.3.2 Clinical (presumptive) diagnosis
2.3.3 Antigen detection tests
2.3.4 Molecular tests
2.3.5 Serology
2.4 Drugs available for treatment of malaria
2.4.1 Quinine and related compounds
2.4.2 Antifolate combination drugs
2.4.3 Antibiotics
2.4.4 Artemisinin compounds
2.4.5 Miscellaneous compounds
2.4.6 Combination therapy with antimalarials
2.5 Current status of drug-resistant malaria

3. Causes of resistance
3.1 Definition of antimalarial drug resistance
3.2 Malaria treatment failure
3.3 Mechanisms of antimalarial resistance
3.3.1 Chloroquine resistance
3.3.2 Antifolate combination drugs
3.3.3 Atovaquone
3.4 Factors contributing to the spread of resistance
3.4.1 Biological influences on resistance
3.4.2 Programmatic influences on resistance

4. Detection of resistance
4.1 In vivo tests
4.2 In vitro tests
4.3 Animal model studies
4.4 Molecular techniques
4.5 Case reports and passive detection of treatment failure

5. Treatment

6. The future: prevention of drug resistance
6.1 Preventing drug resistance
6.1.1 Reducing overall drug pressure
6.1.2 Improving the way drugs are used
6.1.3 Combination therapy

7. Conclusions and recommendations
7.1 Priorities

8. Bibliography

Figure and tables
Figure 1.Approximate distribution of malaria
Table 1.Comparative descriptions of available malaria diagnostic methods
Table 2.Antimalarial drugs for uncomplicated malaria
Table 3.Distribution of drug-resistant Plasmodium falciparum malaria

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