Drug resistance in the Malaria Endemic World
The development of resistance to drugs poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality. Drug resistance has been confirmed in only 2 of the 4 human malaria parasite species, Plasmodium falciparum and P. vivax.
Drug-resistant P. falciparum
Chloroquine resistant P. falciparum (CRPF) first developed independently in 3 to 4 foci in Southeast Asia, Oceania, and South America in the late 1950's and early 1960's. Since then, chloroquine resistance has spread to nearly all areas of the world where falciparum malaria is transmitted.
P. falciparum has also developed resistance to nearly all of the other currently available antimalarial drugs, such as sulfadoxine/ pyrimethamine, mefloquine, halofantrine, and quinine. Although resistance to these drugs tends to be much less widespread geographically, in some areas of the world, the impact of multi-drug resistant malaria can be extensive. Most recently, artemisinin resistance appears to be emerging in parts of Southeast Asia.
Drug-resistant P. vivax
Chloroquine resistant P. vivax (CRPV) malaria was first identified in 1989 among Australians living in or traveling to Papua New Guinea. CRPV has also now been identified in Southeast Asia, on the Indian subcontinent, and in South America. Vivax malaria, particularly from Oceania, also exhibits decreased susceptibility to primaquine.
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