Malaria drug - resistance in Iran

Introduction: Malaria is a public health problem for approximately 2.4 billion
people, 40% of the world’s population, particularly in the tropical and subtropical
countries. Countries in Asia, and Latin America, the islands of the South, West,
and central pacific ocean are all affected. Drug resistance is the greatest challenge
in combating against malaria. Drug resistance in malaria is now widespread and
increasingly has sophisticated the treatment in many parts of the world. This
review study was conducted to determine the present situation of malaria drug
resistance.
Chloriquine, the most valuable antimalaria, has been the drug of choice for
treatment of malaria all over the country almost for half a century. It is well
absorbed, well tolerated, and inexpensive. However, the first report of
chloroquine-resistant flaciparum malaria was published by Edrissian two decades
ago. Consequently, mosquitoes of the Anopheles species spread the drug resistant
parasite strians throughout the malarious areas of Iran. As a result, both
prevalence and intensification of resistance has increased. Recent study has
located several mutated genes responsible for plasmodium falciparum resistance
to chloroquine and sulfadoxine/pyrimethamine combination. Application of genetic
information for early detection of resistance foci and further monitoring of drug
resistant malaria is a useful epidemiological tool in comparison with traditional
methods. There is much to be done in the research of malaria and its treatment.
Conclusion: Education on the prevention of malaria is greatly needed. Treatment
of malaria with a single drug should no longer be regarded as ethical.
Combination of two antimalarial with independednt mode of action should replace
the conventional treatment. Although, recently combination of chloroquine and
fansidar has been introduced as the first line treatment in falciparum malaria,
nevertheless experiences in other countries reveal that such a combination is not
suitable. It is highly suggested that the present first line drug should switch to the
newly formulated antimalarials, i.e. artesunate, a derivative of artemisinine, not
only is able to diminish the problem, but also due to its brilliant therapeutic
efficacy, resolves the patient’s symptoms rapidly and prevents treatment failures
as well. Furthermore, gametocyte rate will decrease too.