Kager P A, Wetsteyn J C
Academisch Medisch Centrum, afd. Inwendige Geneeskunde, Amsterdam.
Ned Tijdschr Geneeskd. 1996 Jan 20;140(3):151-5.
Drug resistance is a major problem in malaria. The resistance mechanism remains unresolved but contributing factors are probably heavy drug use, parasite selection, cross resistance and genetic influences of drugs. Plasmodium ovale en P. malariae are sensitive to the current antimalarial drugs. P. vivax has some chloroquine resistant strains, notably on Papua New Guinea, Irian Jaya and other islands in the Pacific. The geographical distribution of P. falciparum strains resistant to proguanil and pyrimethamine is not well known. Chloroquine-resistant strains are found in South East Asia, the Amazon region (almost 100% resistance in both regions) and in Africa south of the Sahara (resistance not everywhere 100%). Sulfadoxine-pyrimethamine is not an effective treatment in South East Asia and the Amazon region; it is useful in tropical Africa. Mefloquine resistance is a problem mainly confined to Thailand. There is cross resistance between halofantrine and mefloquine. Decreased sensitivity to quinine was reported from Thailand, but it remains an effective drug, notably when given in combination with tetracycline or doxycycline. In cases of severe or complicated malaria intravenous quinine is still the preferred therapy. Resistance to artemisinine has not yet been reported. Pharmaceutical companies show little interest in antimalarial drug development, which in view of the increasing drug resistance is a matter of great concern.
耐药性是疟疾治疗中的一个主要问题。耐药机制尚未明确，但促成因素可能包括大量用药、寄生虫选择、交叉耐药性以及药物的遗传影响。卵形疟原虫和三日疟原虫对目前的抗疟药物敏感。间日疟原虫有一些耐氯喹的菌株，特别是在巴布亚新几内亚、伊里安查亚和太平洋的其他岛屿上。对氯胍和乙胺嘧啶耐药的恶性疟原虫菌株的地理分布情况尚不清楚。耐氯喹的菌株在东南亚、亚马逊地区（这两个地区的耐药率几乎达100%）以及撒哈拉以南非洲地区（并非所有地方的耐药率都达100%）均有发现。磺胺多辛 - 乙胺嘧啶在东南亚和亚马逊地区不是一种有效的治疗药物；它在热带非洲地区有用。甲氟喹耐药性主要是泰国存在的一个问题。卤泛群与甲氟喹之间存在交叉耐药性。泰国报告了对奎宁敏感性降低的情况，但它仍然是一种有效的药物，特别是与四环素或强力霉素联合使用时。在严重或复杂疟疾的病例中，静脉注射奎宁仍然是首选疗法。尚未有对青蒿素耐药的报告。制药公司对开发抗疟药物兴趣不大，鉴于耐药性不断增加，这是一个令人极为担忧的问题。
