Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India
Drug resistance in Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, t...
Gespeichert in:
Veröffentlicht in: | Acta tropica 2009-07, Vol.111 (1), p.21-28 |
---|---|
Hauptverfasser: | , , , , , , , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 28 |
---|---|
container_issue | 1 |
container_start_page | 21 |
container_title | Acta tropica |
container_volume | 111 |
creator | Valecha, N. Joshi, H. Mallick, P.K. Sharma, S.K. Kumar, A. Tyagi, P.K. Shahi, B. Das, M.K. Nagpal, B.N. Dash, A.P. |
description | Drug resistance in
Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, the extent of the problem was realized only after the more intensive 28-day drug efficacy studies were used to monitor drug resistance. In the present study, efficacy of chloroquine in treatment of uncomplicated
falciparum malaria was investigated using standard World Health Organization (WHO) procedures in three distinct epidemiological settings. The prevalence of molecular markers of drug resistance,
Pfcrt K76T,
Pfmdr1 N86Y, was also studied. A total of 374 children and adults with uncomplicated
P. falciparum malaria were enrolled at six sites in four states, treated with chloroquine and follow-up was done for 28 days.
The cumulative incidence of success of chloroquine at Day 28 by the Kaplan Meier analysis in the state of Orissa (District Sundargarh, CHC Bisra and Kuarmunda) was 57 (95% CI 43–68) and 54 (95% CI 40–66); in the state of Jharkhand (District Ranchi, PHC Angara and District Simdega, PHC Jaldega) it was 72 (95% CI 59–81) and 65 (95% CI 50–76); in the state of Goa (District North-Goa, Panaji Town), it was 20 (95% CI 10–2) and in the state of Rajasthan (District Udaipur, PHC Rishabdev), it was 96 (95% CI 85–99).
Treatment failure was related to
Pfcrt mutations but not
Pfmdr mutations. Early treatment failure was observed only in 15.8% out of total failures, probably due to the semi-immune nature of the population. This type of response may give false perception about efficacy of the failing drug to patients, clinicians and National Authorities.
In a large country like India it is not feasible to conduct
in vivo studies in all districts and lack of direct correlation between molecular markers,
in vitro studies and treatment outcome makes it difficult to predict the areas requiring change of policy. In this scenario, it is a challenge for National Programmes to make evidence-based revisions in the drug policy. However, considering the global, especially Southeast Asian, scenario and interpretation of available
in vivo data, trends of mutations, availability of effective drugs and support of international donors, India should consider changing the first line treatment, at least for all diagnosed
P. falciparum cases. |
doi_str_mv | 10.1016/j.actatropica.2009.01.013 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67215532</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0001706X0900031X</els_id><sourcerecordid>67215532</sourcerecordid><originalsourceid>FETCH-LOGICAL-c436t-ff4b1710d65128c4bf305e4bfe9eb3bcbad1c60f19e8542841504bb09b8e23103</originalsourceid><addsrcrecordid>eNqNkU2LFDEQhoMo7uzqX5B40FuP-e5ubzKouzDgZQVvIUlXmAzdyZj07O78e9PMoN4UCooiT1Xeqheht5SsKaHqw35t3GzmnA7BmTUjpF8TWoM_QyvatbxRTIrnaEUIoU1L1I8rdF3KvlaslewluqK9YErJboWetukRg_d1kDvh5LHbjSmnn8cQ4SO-DxPgOeHyGGa3Sw-Ql8rkGaZQQgyxsabAgF2abIhmDinieQfZHE7Yp4y9GV04mHyc8GRGk4PBIeK7OATzCr2orwVeX_IN-v7l8_3mttl--3q3-bRtnOBqbrwXlraUDEpS1jlhPScSaoIeLLfOmoE6RTztoZOCdYJKIqwlve2AcUr4DXp_nntYtoIy6yrdwTiaCOlYtGoZlZKzf4KMKCFZSyvYn0GXUykZvD7kMJl80pToxR-913_5oxd_NKE1eO19c_nkaCcY_nReDKnAuwtgijOjzya6UH5zVSvtuVjUbs4c1Ns9BMi6uADRwRAyuFkPKfyHnF-aX7Za</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>20645271</pqid></control><display><type>article</type><title>Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Valecha, N. ; Joshi, H. ; Mallick, P.K. ; Sharma, S.K. ; Kumar, A. ; Tyagi, P.K. ; Shahi, B. ; Das, M.K. ; Nagpal, B.N. ; Dash, A.P.</creator><creatorcontrib>Valecha, N. ; Joshi, H. ; Mallick, P.K. ; Sharma, S.K. ; Kumar, A. ; Tyagi, P.K. ; Shahi, B. ; Das, M.K. ; Nagpal, B.N. ; Dash, A.P.</creatorcontrib><description>Drug resistance in
Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, the extent of the problem was realized only after the more intensive 28-day drug efficacy studies were used to monitor drug resistance. In the present study, efficacy of chloroquine in treatment of uncomplicated
falciparum malaria was investigated using standard World Health Organization (WHO) procedures in three distinct epidemiological settings. The prevalence of molecular markers of drug resistance,
Pfcrt K76T,
Pfmdr1 N86Y, was also studied. A total of 374 children and adults with uncomplicated
P. falciparum malaria were enrolled at six sites in four states, treated with chloroquine and follow-up was done for 28 days.
The cumulative incidence of success of chloroquine at Day 28 by the Kaplan Meier analysis in the state of Orissa (District Sundargarh, CHC Bisra and Kuarmunda) was 57 (95% CI 43–68) and 54 (95% CI 40–66); in the state of Jharkhand (District Ranchi, PHC Angara and District Simdega, PHC Jaldega) it was 72 (95% CI 59–81) and 65 (95% CI 50–76); in the state of Goa (District North-Goa, Panaji Town), it was 20 (95% CI 10–2) and in the state of Rajasthan (District Udaipur, PHC Rishabdev), it was 96 (95% CI 85–99).
Treatment failure was related to
Pfcrt mutations but not
Pfmdr mutations. Early treatment failure was observed only in 15.8% out of total failures, probably due to the semi-immune nature of the population. This type of response may give false perception about efficacy of the failing drug to patients, clinicians and National Authorities.
In a large country like India it is not feasible to conduct
in vivo studies in all districts and lack of direct correlation between molecular markers,
in vitro studies and treatment outcome makes it difficult to predict the areas requiring change of policy. In this scenario, it is a challenge for National Programmes to make evidence-based revisions in the drug policy. However, considering the global, especially Southeast Asian, scenario and interpretation of available
in vivo data, trends of mutations, availability of effective drugs and support of international donors, India should consider changing the first line treatment, at least for all diagnosed
P. falciparum cases.</description><identifier>ISSN: 0001-706X</identifier><identifier>EISSN: 1873-6254</identifier><identifier>DOI: 10.1016/j.actatropica.2009.01.013</identifier><identifier>PMID: 19426658</identifier><identifier>CODEN: ACTRAQ</identifier><language>eng</language><publisher>Oxford: Elsevier B.V</publisher><subject>Adolescent ; Adult ; Aged ; Animals ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiparasitic agents ; Artemisinin-based combination therapy ; ATP-Binding Cassette Transporters - genetics ; Biological and medical sciences ; Child ; Child, Preschool ; Chloroquine ; Chloroquine - pharmacology ; Chloroquine - therapeutic use ; Drug Resistance ; Female ; General aspects ; Human protozoal diseases ; Humans ; India ; Infant ; Infectious diseases ; Malaria ; Malaria, Falciparum - drug therapy ; Male ; Medical sciences ; Membrane Transport Proteins - genetics ; Middle Aged ; Mutation, Missense ; New infection ; Parasitic diseases ; Pharmacology. Drug treatments ; Plasmodium falciparum ; Plasmodium falciparum - drug effects ; Plasmodium falciparum - genetics ; Protozoal diseases ; Protozoan Proteins - genetics ; Recrudescence ; Treatment Failure ; Treatment Outcome ; Young Adult</subject><ispartof>Acta tropica, 2009-07, Vol.111 (1), p.21-28</ispartof><rights>2009 Elsevier B.V.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-ff4b1710d65128c4bf305e4bfe9eb3bcbad1c60f19e8542841504bb09b8e23103</citedby><cites>FETCH-LOGICAL-c436t-ff4b1710d65128c4bf305e4bfe9eb3bcbad1c60f19e8542841504bb09b8e23103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.actatropica.2009.01.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21519342$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19426658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Valecha, N.</creatorcontrib><creatorcontrib>Joshi, H.</creatorcontrib><creatorcontrib>Mallick, P.K.</creatorcontrib><creatorcontrib>Sharma, S.K.</creatorcontrib><creatorcontrib>Kumar, A.</creatorcontrib><creatorcontrib>Tyagi, P.K.</creatorcontrib><creatorcontrib>Shahi, B.</creatorcontrib><creatorcontrib>Das, M.K.</creatorcontrib><creatorcontrib>Nagpal, B.N.</creatorcontrib><creatorcontrib>Dash, A.P.</creatorcontrib><title>Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India</title><title>Acta tropica</title><addtitle>Acta Trop</addtitle><description>Drug resistance in
Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, the extent of the problem was realized only after the more intensive 28-day drug efficacy studies were used to monitor drug resistance. In the present study, efficacy of chloroquine in treatment of uncomplicated
falciparum malaria was investigated using standard World Health Organization (WHO) procedures in three distinct epidemiological settings. The prevalence of molecular markers of drug resistance,
Pfcrt K76T,
Pfmdr1 N86Y, was also studied. A total of 374 children and adults with uncomplicated
P. falciparum malaria were enrolled at six sites in four states, treated with chloroquine and follow-up was done for 28 days.
The cumulative incidence of success of chloroquine at Day 28 by the Kaplan Meier analysis in the state of Orissa (District Sundargarh, CHC Bisra and Kuarmunda) was 57 (95% CI 43–68) and 54 (95% CI 40–66); in the state of Jharkhand (District Ranchi, PHC Angara and District Simdega, PHC Jaldega) it was 72 (95% CI 59–81) and 65 (95% CI 50–76); in the state of Goa (District North-Goa, Panaji Town), it was 20 (95% CI 10–2) and in the state of Rajasthan (District Udaipur, PHC Rishabdev), it was 96 (95% CI 85–99).
Treatment failure was related to
Pfcrt mutations but not
Pfmdr mutations. Early treatment failure was observed only in 15.8% out of total failures, probably due to the semi-immune nature of the population. This type of response may give false perception about efficacy of the failing drug to patients, clinicians and National Authorities.
In a large country like India it is not feasible to conduct
in vivo studies in all districts and lack of direct correlation between molecular markers,
in vitro studies and treatment outcome makes it difficult to predict the areas requiring change of policy. In this scenario, it is a challenge for National Programmes to make evidence-based revisions in the drug policy. However, considering the global, especially Southeast Asian, scenario and interpretation of available
in vivo data, trends of mutations, availability of effective drugs and support of international donors, India should consider changing the first line treatment, at least for all diagnosed
P. falciparum cases.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Animals</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiparasitic agents</subject><subject>Artemisinin-based combination therapy</subject><subject>ATP-Binding Cassette Transporters - genetics</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chloroquine</subject><subject>Chloroquine - pharmacology</subject><subject>Chloroquine - therapeutic use</subject><subject>Drug Resistance</subject><subject>Female</subject><subject>General aspects</subject><subject>Human protozoal diseases</subject><subject>Humans</subject><subject>India</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Malaria</subject><subject>Malaria, Falciparum - drug therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Membrane Transport Proteins - genetics</subject><subject>Middle Aged</subject><subject>Mutation, Missense</subject><subject>New infection</subject><subject>Parasitic diseases</subject><subject>Pharmacology. Drug treatments</subject><subject>Plasmodium falciparum</subject><subject>Plasmodium falciparum - drug effects</subject><subject>Plasmodium falciparum - genetics</subject><subject>Protozoal diseases</subject><subject>Protozoan Proteins - genetics</subject><subject>Recrudescence</subject><subject>Treatment Failure</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0001-706X</issn><issn>1873-6254</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU2LFDEQhoMo7uzqX5B40FuP-e5ubzKouzDgZQVvIUlXmAzdyZj07O78e9PMoN4UCooiT1Xeqheht5SsKaHqw35t3GzmnA7BmTUjpF8TWoM_QyvatbxRTIrnaEUIoU1L1I8rdF3KvlaslewluqK9YErJboWetukRg_d1kDvh5LHbjSmnn8cQ4SO-DxPgOeHyGGa3Sw-Ql8rkGaZQQgyxsabAgF2abIhmDinieQfZHE7Yp4y9GV04mHyc8GRGk4PBIeK7OATzCr2orwVeX_IN-v7l8_3mttl--3q3-bRtnOBqbrwXlraUDEpS1jlhPScSaoIeLLfOmoE6RTztoZOCdYJKIqwlve2AcUr4DXp_nntYtoIy6yrdwTiaCOlYtGoZlZKzf4KMKCFZSyvYn0GXUykZvD7kMJl80pToxR-913_5oxd_NKE1eO19c_nkaCcY_nReDKnAuwtgijOjzya6UH5zVSvtuVjUbs4c1Ns9BMi6uADRwRAyuFkPKfyHnF-aX7Za</recordid><startdate>20090701</startdate><enddate>20090701</enddate><creator>Valecha, N.</creator><creator>Joshi, H.</creator><creator>Mallick, P.K.</creator><creator>Sharma, S.K.</creator><creator>Kumar, A.</creator><creator>Tyagi, P.K.</creator><creator>Shahi, B.</creator><creator>Das, M.K.</creator><creator>Nagpal, B.N.</creator><creator>Dash, A.P.</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>C1K</scope><scope>F1W</scope><scope>H95</scope><scope>H97</scope><scope>L.G</scope><scope>M7N</scope><scope>7X8</scope></search><sort><creationdate>20090701</creationdate><title>Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India</title><author>Valecha, N. ; Joshi, H. ; Mallick, P.K. ; Sharma, S.K. ; Kumar, A. ; Tyagi, P.K. ; Shahi, B. ; Das, M.K. ; Nagpal, B.N. ; Dash, A.P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-ff4b1710d65128c4bf305e4bfe9eb3bcbad1c60f19e8542841504bb09b8e23103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Animals</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiparasitic agents</topic><topic>Artemisinin-based combination therapy</topic><topic>ATP-Binding Cassette Transporters - genetics</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Chloroquine</topic><topic>Chloroquine - pharmacology</topic><topic>Chloroquine - therapeutic use</topic><topic>Drug Resistance</topic><topic>Female</topic><topic>General aspects</topic><topic>Human protozoal diseases</topic><topic>Humans</topic><topic>India</topic><topic>Infant</topic><topic>Infectious diseases</topic><topic>Malaria</topic><topic>Malaria, Falciparum - drug therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Membrane Transport Proteins - genetics</topic><topic>Middle Aged</topic><topic>Mutation, Missense</topic><topic>New infection</topic><topic>Parasitic diseases</topic><topic>Pharmacology. Drug treatments</topic><topic>Plasmodium falciparum</topic><topic>Plasmodium falciparum - drug effects</topic><topic>Plasmodium falciparum - genetics</topic><topic>Protozoal diseases</topic><topic>Protozoan Proteins - genetics</topic><topic>Recrudescence</topic><topic>Treatment Failure</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Valecha, N.</creatorcontrib><creatorcontrib>Joshi, H.</creatorcontrib><creatorcontrib>Mallick, P.K.</creatorcontrib><creatorcontrib>Sharma, S.K.</creatorcontrib><creatorcontrib>Kumar, A.</creatorcontrib><creatorcontrib>Tyagi, P.K.</creatorcontrib><creatorcontrib>Shahi, B.</creatorcontrib><creatorcontrib>Das, M.K.</creatorcontrib><creatorcontrib>Nagpal, B.N.</creatorcontrib><creatorcontrib>Dash, A.P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta tropica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Valecha, N.</au><au>Joshi, H.</au><au>Mallick, P.K.</au><au>Sharma, S.K.</au><au>Kumar, A.</au><au>Tyagi, P.K.</au><au>Shahi, B.</au><au>Das, M.K.</au><au>Nagpal, B.N.</au><au>Dash, A.P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India</atitle><jtitle>Acta tropica</jtitle><addtitle>Acta Trop</addtitle><date>2009-07-01</date><risdate>2009</risdate><volume>111</volume><issue>1</issue><spage>21</spage><epage>28</epage><pages>21-28</pages><issn>0001-706X</issn><eissn>1873-6254</eissn><coden>ACTRAQ</coden><abstract>Drug resistance in
Plasmodium falciparum poses a major threat to malaria control globally; including India. Chloroquine is still the most widely used drug in the country because of its safety and cost effectiveness. Although chloroquine resistance was first reported in 1973 in North Eastern India, the extent of the problem was realized only after the more intensive 28-day drug efficacy studies were used to monitor drug resistance. In the present study, efficacy of chloroquine in treatment of uncomplicated
falciparum malaria was investigated using standard World Health Organization (WHO) procedures in three distinct epidemiological settings. The prevalence of molecular markers of drug resistance,
Pfcrt K76T,
Pfmdr1 N86Y, was also studied. A total of 374 children and adults with uncomplicated
P. falciparum malaria were enrolled at six sites in four states, treated with chloroquine and follow-up was done for 28 days.
The cumulative incidence of success of chloroquine at Day 28 by the Kaplan Meier analysis in the state of Orissa (District Sundargarh, CHC Bisra and Kuarmunda) was 57 (95% CI 43–68) and 54 (95% CI 40–66); in the state of Jharkhand (District Ranchi, PHC Angara and District Simdega, PHC Jaldega) it was 72 (95% CI 59–81) and 65 (95% CI 50–76); in the state of Goa (District North-Goa, Panaji Town), it was 20 (95% CI 10–2) and in the state of Rajasthan (District Udaipur, PHC Rishabdev), it was 96 (95% CI 85–99).
Treatment failure was related to
Pfcrt mutations but not
Pfmdr mutations. Early treatment failure was observed only in 15.8% out of total failures, probably due to the semi-immune nature of the population. This type of response may give false perception about efficacy of the failing drug to patients, clinicians and National Authorities.
In a large country like India it is not feasible to conduct
in vivo studies in all districts and lack of direct correlation between molecular markers,
in vitro studies and treatment outcome makes it difficult to predict the areas requiring change of policy. In this scenario, it is a challenge for National Programmes to make evidence-based revisions in the drug policy. However, considering the global, especially Southeast Asian, scenario and interpretation of available
in vivo data, trends of mutations, availability of effective drugs and support of international donors, India should consider changing the first line treatment, at least for all diagnosed
P. falciparum cases.</abstract><cop>Oxford</cop><pub>Elsevier B.V</pub><pmid>19426658</pmid><doi>10.1016/j.actatropica.2009.01.013</doi><tpages>8</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0001-706X |
ispartof | Acta tropica, 2009-07, Vol.111 (1), p.21-28 |
issn | 0001-706X 1873-6254 |
language | eng |
recordid | cdi_proquest_miscellaneous_67215532 |
source | MEDLINE; Elsevier ScienceDirect Journals Complete |
subjects | Adolescent Adult Aged Animals Antibiotics. Antiinfectious agents. Antiparasitic agents Antiparasitic agents Artemisinin-based combination therapy ATP-Binding Cassette Transporters - genetics Biological and medical sciences Child Child, Preschool Chloroquine Chloroquine - pharmacology Chloroquine - therapeutic use Drug Resistance Female General aspects Human protozoal diseases Humans India Infant Infectious diseases Malaria Malaria, Falciparum - drug therapy Male Medical sciences Membrane Transport Proteins - genetics Middle Aged Mutation, Missense New infection Parasitic diseases Pharmacology. Drug treatments Plasmodium falciparum Plasmodium falciparum - drug effects Plasmodium falciparum - genetics Protozoal diseases Protozoan Proteins - genetics Recrudescence Treatment Failure Treatment Outcome Young Adult |
title | Low efficacy of chloroquine: Time to switchover to artemisinin-based combination therapy for falciparum malaria in India |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T13%3A13%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Low%20efficacy%20of%20chloroquine:%20Time%20to%20switchover%20to%20artemisinin-based%20combination%20therapy%20for%20falciparum%20malaria%20in%20India&rft.jtitle=Acta%20tropica&rft.au=Valecha,%20N.&rft.date=2009-07-01&rft.volume=111&rft.issue=1&rft.spage=21&rft.epage=28&rft.pages=21-28&rft.issn=0001-706X&rft.eissn=1873-6254&rft.coden=ACTRAQ&rft_id=info:doi/10.1016/j.actatropica.2009.01.013&rft_dat=%3Cproquest_cross%3E67215532%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=20645271&rft_id=info:pmid/19426658&rft_els_id=S0001706X0900031X&rfr_iscdi=true |