Potential Factors Responsible for the Development of Plasmodium falciparum and Plasmodium vivax Resistance to Anti-malarial Drugs in Some Parts of India

Indiscriminate use of chloroquine (CQ) has resulted in chloroquine resistance in Plasmodium falciparum (Pf) in almost all regions of India. Due to the emergence of resistance to CQ in India, the current recommended first line of treatment for Pf has been the combination of artesunate with sulfadoxine-pyrimethamine (SP). Recently, chloroquine resistance to Plasmodium vivax (Pv) has also emerged in some parts of India. Poor drug quality and under dosing of antimalarial treatment are potential factors of drug resistance to malaria parasite. A caution is thus required for quality control of antimalarial drugs now in use and also inadequate treatment. There is an urgent need to strengthen National Drug Control Policy to empower Central Drugs Standard Control Organization to enforce definitive antimalarial drug legislations. Improvement in quality control in production and distribution of antimalarial drugs in India, combined with informed and enforced national guidance on the treatment of malaria, will help to combat the emergence of resistance to antimalarial drugs.