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A Clinical Experience of Drug Resistance in Malaria among Admitted Paediatric Patients

Volumn 34, Issue 1 - March 01, 2010

Objective: To assess the state of drug resistance to malaria in admitted paediatric patients and to identify the most frequent species associated with the drug resistance.

Design: Descriptive observational study. Place and Duration of Study: Paediatric ward of Dow University of Health Sciences and Civil Hospital Karachi. August to November 2007.

Subjects and Methods: patients aged > one month to 15 years who were admitted with the signs and symptoms suggestive of malaria were classified as uncomplicated or complicated (severe) malaria. They were checked for Malarial Parasite (MP) using the peripheral blood film and/or ICT. Patients with uncomplicated malaria shown positive for the MP were put on oral chloroquin. Those showing inadequate response or no response to chloroquin with persistent MP were put successively on oral quinine, artemether and combination of artemether and lumifantrine. The patients classified as severe or complicated malaria were treated with injection quinine. This was followed by successive administration of injection artemether and then combination of oral artemether and lumifantrine as they persisted to have the clinical disease along with a positive MP. The drug resistance was assessed using the clinical response to the drug along with the identification of the M.P on the peripheral blood film. Frequency of malarial resistance against single and multiple antimalarial drugs was noted. The plasmodium species in resistant malaria were also identified. Data was analyzed using SPSS version 15 ofthe windows. Discrete variables were expressed as frequencies. Chi square test was applied to assess the significance of results. P-value of <0.05 was considered significant.

Results: A total of 56 patients were recruited in the study with the diagnosis of malaria. About 59% of the patients were classified as severe or complicated malaria. 42% of the patients with severe malaria who were initially put on injection Quinine were found to be resistant to the drug. 7 out of 14 patients were resistant to Artemether also. 5 out of 6 patients who were resistant to Artemether were responsive to combination of oral artemether and lumifantrine while one patient put on the combination therapy continued to have the symptoms till death. In uncomplicated malaria 39% of the patients were resistant to Chloroquin. 7 out of 9 patients resistant to Chloroquin responded to oral quinine while the remaining 2 responded to artemether. Overall single drug resistance was shown in 39% for chloroquin and 42% for quinine. Multi drug resistance was witnessed in 23 (41.07%) patients. Plasmodium falciparum was found to be affected most frequently by resistance against chloroquin while there was no particular predilection among various plasmodium species for resistance against the rest of the antimalarial drugs

Conclusion: Resistance is being witnessed to the standard recommended antimalarial drugs including Artemether, though we do need to study on larger sample of patients for the statistically significant results. No significant difference was noticed among the various plasmodium species regarding the resistance against most of the antimalarial drugs.

Key Words: Malaria, Drug resistance, Quinine, Chloroquin, Artemether.

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