This story is from October 20, 2017

Drug-resistant malaria adds to city dengue sting

As the city battles a fresh outbreak of dengue, treatment of malaria has been hit by a growing resistance to chloroquine, the primary drug against the vector-borne disease.
Drug-resistant malaria adds to city dengue sting
Representative image
KOLKATA: As the city battles a fresh outbreak of dengue, treatment of malaria has been hit by a growing resistance to chloroquine, the primary drug against the vector-borne disease.
Doctors across hospitals and clinics are worried by the inefficacy of the medicine that would treat malaria in 4-5 days till a few years ago. Around 40% of malaria patients in the city don’t respond to chloroquine any more, say experts.
The artemisinin group of drugs — administered both orally and through the intravenous route — is being used more frequently as an alternative.
The city has been fortunate that a malaria outbreak didn’t accompany the dengue spurt, said Arindam Biswas, senior consultant in general medicine at RN Tagore International Institute of Cardiac Sciences. “Nine of 10 malaria patients I treated over the last three months showed resistance to chloroquine. This is alarming, though the number of chloroquine-resistant patients has been steadily increasing over the last five years. It has been the primary malaria drug for years and remains so. But now, doctors and patients must be on their toes, for there is a 50% possibility of chloroquine not working,” said Biswas.
Behala resident Tathagata Roy was admitted to a hospital off EM Bypass with malaria last month. His fever refused to subside despite a course of chloroquine. Doctors finally switched to injectable artesunate — an artemisinin group of drug. “His resistance was detected in time and he responded to the alternative,” said his father, Bhabatosh Roy. Chloroquine is used in both types of malaria, vivax and falciparum.
Unless more alternatives are devised, malaria treatment would be difficult in the near future, said Shyamisis Bandopadhyay, senior consultant, Apollo Gleneagles Hospital. “I came across two cases of resistance in the last few weeks. It has been growing due to two major reasons. First, chloroquine has been used indiscriminately for many years, leading to resistance. Secondly, the malaria parasite has undergone a genotype change. It can now counter chloroquine. So, the answer is to find new drugs that would negate the new smarter viruses,” said Bandopadhyay.

While the artemisinin group is an effective alternative, the drugs could lose efficacy and should be used sparingly, along with other medicines, felt Debashish Saha, a senior consultant at AMRI Hospital. “Artesunate is the most effective of the group. In case a malaria patient is showing signs of multi-organ failure, bleeding or sepsis, artesunate is now the best bet. It could be dangerous to use chloroquine since the patient could be resistant to it and treatment may turn ineffective. But even then, artesunate needs to be used judiciously,” said Saha.
Artemisinin drugs can be given orally, or through the intramuscular and intravenous routes. “Artesunate is preferable in resistant cases and is given in the intravenous form. Chloroquine resistance may develop due to mutation, poor compliance on the part of the patient, poor absorption of the drug or genetic changes in the parasites,” said Arindam Biswas, senior consultant in general medicine at RN Tagore International Institute of Cardiac Sciences.
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