Antimalarial of drug resistance. Quinine has been used

Antimalarial drug resistance is now
generally approved to be one of the considerable risk to our ability to ‘Roll
back malaria’. The situation is getting worse; with the growing frequency and rising
drug resistance (Yeung
et al., 2004).
Chloroquin resistant plasmodium falciparum malaria now prevail in South
America, Southeast Asia, and parts of Africa. Resistance to
sulphadoxine-pyrimethamine is common in South America, Asia and and is spred
out in Africa and even quinine has become less efficient over time (Yeung et al., 2004). Conditions are not different in
Pakistan and falciparum malaria is on the progress (Nizamani et al., 2006). In a moment  falciparum malaria accounts for 18% to 62% of
all cases of malaria in different zones of Pakistan with resistance to one or
more antimalarials reaching up to 40% (Khan et al., 2004). Resistance of
falciparum malaria to chloroquin is broadly expand in Pakistan and it is no longer
supported (Shah et al., 1997; Rana et al., 2004). Quinine is the drug of choice for P. falciparum
but irregular cases of resistant strains are being recorded with monotherapy (Jamal et al., 2005;Bhalli et al.,
Artimisinin derivatives are currently useful but are expensive for a developing
country to be used on a mass scale (Laxminarayan et
al., 2004). Recently use of antimalarials in
combination with other antibiotics has been promoted in many countries (Khan et al., 2004). The target are twofold: to manage
synergistic or additive killing of parasites, and to prevent development of
drug resistance. Quinine has been used in combination with , azithromycin, doxycycline,
clindamycin (Alecrim et al., 2006 ; Miller et al., 2006). All have been recorded to be efficient.
There is insufficiency of description in Pakistani medical literature representing
the use of quinine based combination therapy. However it has been recommended
in the guidelines of treatment of falciparum malaria (Khan
et al., 2004).