Epidemiological distribution of Plasmodium falciparum drug resistance in Brazil and its relevance to the treatment and control of malaria

Abstract

With the use of a simple formulary, filled by health agents was established a monitoring programme for responses of P. falciparum to the antimalarial drugs. This monitoring programme is emphasized for the knowledge of the epidemiology of the drug resistance and the control of malaria falciparum in Amazon Basin where occurs more than 95% of Brazilian malaria cases every year. It was demonstrated that still now 4-aminoquinolines have a great importance for the mortality control in areas where just SUCAM (National Health Foundation--Health Ministry) agents are present without any medical assistance. The results obtained permitted the simplification of malaria treatment in Brazil. Important conclusions were established in the field of malaria drug resistance.

Malaria control in an agro-industrial settlement of Rondônia (Western Amazon Region, Brazil)

“…However, our experience in Rondônia over the last five years (unpublished data) coincides with that of De Souza (1992) that confirms that FNS's regimen using associations of quinine with tetracycline, or quinine with oligomycin provide very successful treatments of P. falciparum malaria with no recrudescence.…”

Randomized Controlled Trial of Artesunate Plus Tetracycline Versus Standard Treatment (Quinine Plus Tetracycline) for Uncomplicated Plasmodium falciparum Malaria in Brazil

“…(<J. 11) The WHO criteria are based on the resistance of P. falciparum to 4-aminoquinolines (chloroquine or amodiaquine). Resistance is characterized by identification of recrudescence up to 28 days after treatment initiation in the absence of new infection (e. g. in arcas free from transmission).…”

Chemoresistance of Plasmodium falciparum and Plasmodium vivax parasites in Brazil: consequences on disease morbidity and control

“…This reinforced the call to action for all of the control programs worldwide, as they were now facing the ghost of drug resistance (Souza 1992). The spread of CQ-resistant strains (Box et al 1963, Silva & Lopes 1964) accelerated the search for new drugs and SP was highlighted as the new option for falciparum malaria treatment in the 1970s after a clinical trial that showed a high cure rate of CQ-resistant parasites treated with this drug combination (Walker & Lopez-Antunano 1968 Fatefully, the appearance of SP-resistant P. falciparum parasites was verified in Brazilian isolates from TO (Almeida Netto et al 1972) within a short period of time.…”

“…The spread of CQ-resistant strains (Box et al 1963, Silva & Lopes 1964) accelerated the search for new drugs and SP was highlighted as the new option for falciparum malaria treatment in the 1970s after a clinical trial that showed a high cure rate of CQ-resistant parasites treated with this drug combination (Walker & Lopez-Antunano 1968 Fatefully, the appearance of SP-resistant P. falciparum parasites was verified in Brazilian isolates from TO (Almeida Netto et al 1972) within a short period of time. Soon after, a high degree of SP-chemoresistance in other states from Brazil was reported (Alecrim et al 1982a, b, Souza 1983), leading to a climax of at least 90% SP resistance (SPR) in 1987 (Souza 1992). By the end of the 1980s, treatment failure with CQ was increasing, reaching 100% in some situations (Boulos et al 1986, Kremsner et al 1989, Andrade et al 1992, Couto et al 1995, Segurado et al 1997, Póvoa et al 1998, Zalis et al 1998, Cerutti et al 1999b).…”