PDF《ORIGINAL: ENGLISH》

WHO/CDS/CSR/DRS/2001.

4 ORIGINAL: ENGLISH DISTRIBUTION: GENERAL Drug resistance in malaria Peter B.Bloland World Health Organization Copies can be obtained from the CDS Information Resource Centre World Health Organization,1211 Geneva 27,Switzerland fax:+41

22 791

42 85 ? email:[email protected] WHO/CDS/CSR/DRS/2001.4 ORIGINAL: ENGLISH DISTRIBUTION:GENERAL Drug resistance in malaria Peter B.Bloland Malaria Epidemiology Branch Centers for Disease Control and Prevention Chamblee,GA,United States of America World Health Organization A B A C K G R O U N D D O C U M E N T F O R T H E W H O G L O B A L S T R A T E G Y F O R C O N T A I N M E N T O F A N T I M I C R O B I A L R E S I S T A N C E Acknowledgement The World Health Organization wishes to acknowledge the support of the United States Agency for Inter- national Development (USAID) in the production of this document. ? World Health Organization

2001 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organiza- tion. The document may, however, be freely reviewed, abstracted, reproduced and translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. The designations employed and the presentation of the material in this document, including tables and maps, do not imply the expression of any opinion whatsoever on the part of the secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers'

products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Designed by minimum graphics Printed in Switzerland Contents iii WHO/CDS/CSR/DRS/2001.4 DRUG RESISTANC IN MALARIA 1. Introduction

1 2. Disease incidence and trends

2 2.1 Geographical distribution and populations at risk

2 2.2 Causative agents

3 2.3 Diagnosis

3 2.3.1 Microscopy

3 2.3.2 Clinical (presumptive) diagnosis

3 2.3.3 Antigen detection tests

5 2.3.4 Molecular tests

5 2.3.5 Serology

5 2.4 Drugs available for treatment of malaria

5 2.4.1 Quinine and related compounds

5 2.4.2 Antifolate combination drugs

9 2.4.3 Antibiotics

9 2.4.4 Artemisinin compounds

9 2.4.5 Miscellaneous compounds

9 2.4.6 Combination therapy with antimalarials

10 2.5 Current status of drug-resistant malaria

10 3. Causes of resistance

12 3.1 Definition of antimalarial drug resistance

12 3.2 Malaria treatment failure

12 3.3 Mechanisms of antimalarial resistance

12 3.3.1 Chloroquine resistance

12 3.3.2 Antifolate combination drugs

13 3.3.3 Atovaquone

13 3.4 Factors contributing to the spread of resistance

13 3.4.1 Biological influences on resistance

13 3.4.2 Programmatic influences on resistance

15 4. Detection of resistance

16 4.1 In vivo tests

16 4.2 In vitro tests

17 4.3 Animal model studies

17 4.4 Molecular techniques

17 4.5 Case reports and passive detection of treatment failure

18 5. Treatment

19 6. The future: prevention of drug resistance

20 6.1 Preventing drug resistance