Chloroquine‐ and sulfadoxine‐pyrimethamine‐resistant falciparum malaria in vivo– a pilot study in rural Zambia

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Abstract
Summary background Chloroquine (CQ) and Sulfadoxine‐Pyrimethamine (SP) are the predominantly used antimalarials in Zambia and other parts of East Africa, but increasing resistance of P. falciparum is a major concern. methods Seventy consecutive patients with uncomplicated falciparum malaria were enrolled. In 43 patients, no prior CQ use could be demonstrated by history and urianalysis (qualitative test, Dill & Glazko) and these patients were given CQ; the other 27 had taken CQ before and received SP. results Combined R‐II and R‐III CQ‐resistance was 58% (60% in under‐fives), which is the range previously reported from Zambia. By contrast, SP‐resistance (R‐II and R‐III) was much higher (26%) than previously reported (3% – 17%). The history of prior CQ intake correlated well with the results of the Dill–Glazko test; there was no evidence for prior SP intake to explain these results. conclusion If our findings of SP resistance are confirmed, other drugs such as quinine, atovaquone/proguanil and artemisinin are required to treat malaria in Zambia.