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. 2011 Jan;11(1):57-64.
doi: 10.1016/S1473-3099(10)70214-0.

Antimalarial drug resistance of Plasmodium falciparum in India: changes over time and space

Naman K Shah  1 , Gajender P S Dhillon, Adtiya P Dash, Usha Arora, Steven R Meshnick, Neena Valecha
Affiliations

Antimalarial drug resistance of Plasmodium falciparum in India: changes over time and space

Naman K Shah et al. Lancet Infect Dis. 2011 Jan.

Abstract

After the launch of the National Malaria Control Programme in 1953, the number of malaria cases reported in India fell to an all-time low of 0·1 million in 1965. However, the initial success could not be maintained and a resurgence of malaria began in the late 1960s. Resistance of Plasmodium falciparum to chloroquine was first reported in 1973 and increases in antimalarial resistance, along with rapid urbanisation and labour migration, complicated the challenge that India's large geographical area and population size already pose for malaria control. Although several institutions have done drug-resistance monitoring in India, a complete analysis of countrywide data across institutions does not exist. We did a systematic review of P falciparum malaria drug-efficacy studies in India to summarise drug-resistance data and describe changes over the past 30 years to inform future policy. Continued use of chloroquine for treatment of P falciparum malaria in India will likely be ineffective. Resistance to sulfa-pyrimethamine should be closely monitored to protect the effectiveness of treatment with artesunate plus sulfadoxine-pyrimethamine, which is the new first-line treatment for P falciparum malaria. Strategies to reduce the emergence and spread of future drug resistance need to be proactive and supported by intensive monitoring.

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Conflict of interest statement

Conflicts of interest

We declare that we have no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence and proportion of malaria cases caused by Plasmodium falciparum in India between 1961 and 2007 Data from the National Vector Borne Disease Control Programme (unpublished).
Figure 2
Figure 2
Study selection
Figure 3
Figure 3
Studies of chloroquine resistance with 28-day follow-up and the proportion of treatment failures in India between 1978 and 2007
Figure 4
Figure 4
Number of studies of chloroquine resistance with 28-day follow-up in India between 1978 and 2007 and the proportion of treatment failures greater than or equal to 10%
Figure 5
Figure 5
Districts with 10% or greater chloroquine-treatment failure (red) in any study between 1978 and 2007 and in Plasmodium falciparum endemic areas (pink), and districts without reported P falciparum transmission (blue)
See this image and copyright information in PMC

Comment in

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