Increasing antimalarial drug resistance in Uganda and revision of the national drug policy


Kamya, MR; Bakyaita, NN; Talisuna, AO; Were, WM; Staedke, SG; (2002) Increasing antimalarial drug resistance in Uganda and revision of the national drug policy. Tropical medicine & international health , 7 (12). pp. 1031-41. ISSN 1360-2276 DOI: 10.1046/j.1365-3156.2002.00974.x

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Abstract

Chloroquine (CQ) resistance was first documented in Uganda in 1988. Subsequent surveillance of antimalarial drug resistance, conducted by the Ugandan Ministry of Health and several research organizations, suggests that resistance to CQ is now widespread, reaching critical levels in many areas of the country. In June 2000, the Ministry of Health held a National Consensus Meeting to evaluate the available drug efficacy data and review the national antimalarial drug policy. After extensive debate, the combination of CQ + sulfadoxine-pyrimethamine (SP) was chosen to replace CQ as the first-line treatment of uncomplicated malaria as an interim policy. This review evaluates the in vivo drug efficacy studies conducted in Uganda since 1988 and issues confronted in revision of the drug policy. The Ugandan experience illustrates the challenges faced by sub-Saharan African countries confronted with rising CQ resistance but limited data on potential alternative options. The choice of CQ + SP as a provisional policy in the absence of prerequisite efficacy, safety and cost-effectiveness data reflects the urgency of the malaria treatment problem, and growing pressure to adopt combination therapies. Surveillance of CQ + SP treatment efficacy, collection of additional data on alternative regimens and active consensus building among key partners in the malaria community will be necessary to develop a rational long-term antimalarial treatment policy in Uganda.

Item Type: Article
Keywords: Animals, Antimalarials/*therapeutic use, Child, Preschool, Chloroquine/*therapeutic use, Databases, Factual, Evaluation Studies, *Health Policy, Humans, Infant, Infant, Newborn, Insect Vectors, Insecticide Resistance, Malaria, Falciparum/*drug therapy, *Plasmodium falciparum, Uganda, Animals, Antimalarials, therapeutic use, Child, Preschool, Chloroquine, therapeutic use, Databases, Factual, Evaluation Studies, Health Policy, Humans, Infant, Infant, Newborn, Insect Vectors, Insecticide Resistance, Malaria, Falciparum, drug therapy, Plasmodium falciparum, Uganda
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: Antimicrobial Resistance Centre (AMR)
Malaria Centre
PubMed ID: 12460394
Web of Science ID: 179548800006
URI: http://researchonline.lshtm.ac.uk/id/eprint/10202

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