Department of Child Health, Medical Faculty, University of Sumatera Utara
Malaria continues to be a major cause of childhood mortality and was responsible for an estimated 303,000 (165,000-450,000) deaths in children under 5 years old in 2015. Resistance to the antimalarial drugs has increased the mortality and morbidity rate that is achieved so far through the malaria control program. Monitoring the drug resistance to the available antimalarial drugs helps to implement effective drug policy, through the in vivo efficacy studies, in vitro drug susceptibility tests and detection of molecular markers. According to the WHO, parasite resistance to antimalarial medicines has been documented in 3 of the 5 malaria species known to affect humans : P. falciparum, P. vivax, and P. malariae. Parasite resistance results in a delayed or incomplete clearance of parasites from the patient’s blood when the person is being treated with an antimalarial.
The problem of antimalarial drug resistance is compounded by cross resistance, in which resistance to one drug confers resistance to other drugs that belong to the same chemical family or which have similar modes of action.
Antimalarial drug resistance is of great concern in the WHO South-East Asia (SEA) Region. A high degree of resistance of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine is prevalent in this Region. Emergence of artemisinin resistance at the Thai-Cambodia border has been reported recently. For P. vivax, chloroquine (CQ) remains an effective firt-line treatment in many countries, except in Indonesia.
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