Indian physicians concerned about malaria drug resistance, recommend combination therapy

India has reported an increase in drug-resistant malaria cases this year, leading physicians to express concern and recommend that the disease be treated with a combination of drugs, India's Daily News and Analysis reports.

A study conducted by the Clinical Pharmacology Department of King Edward Memorial Hospital found resistance to chloroquine in 5% of Plasmodium falciparum malaria cases in Mumbai, India. According to the Daily News and Analysis, P. falciparum malaria has the most recorded cases of drug resistance. Neelima Kshirsagar -- director of the Maharashtra University of Health Sciences and head of the clinical pharmacology department at KEM Hospital -- said there could be "many reasons" for the increase in drug-resistant malaria cases, such as mutation of a malaria parasite or improper treatment adherence. Malaria parasites have to "mutate to become resistant to [combination treatments], so evolving newer combinations increases the life of the drug used," Suhas Ranade, deputy director of the Directorate of Health Services in Maharashtra state, said. Kshirsagar added that the "full course of seven to 10 days" of treatment must be completed or relapse could occur.

According to the Daily News and Analysis, in the past it took 10 to 15 years for malaria parasites to develop resistance to treatment. However, the "situation is changing fast with doctors having to frequently change the combination of drugs," Kshirsagar said. P. vivax malaria also has shown resistance to treatment, but the low prevalence of this strain "still makes chloroquine the medicine of choice to treat malaria patients," Kishore Harugoli, malaria surveillance officer at the Municipal Corporation of Greater Mumbai, said. The "problem of morbidity with relapses in P. vivax malaria is of great concern," Kshirsagar said.

World Health Organization guidelines indicate that malaria treatment strategies should focus on combination therapy instead of a single medication, the Daily News and Analysis reports (Roy, Daily News and Analysis, 8/24).