Drug Resistance Testing in the United States
Tests for Drug Resistance
There are 4 basic methods for testing malaria for drug resistance: in vivo tests, in vitro tests, molecular characterization, and animal models. Of these, only the first 3 are routinely done.
In vivo tests: In these tests, patients with clinical malaria are given a treatment dose of an antimalarial drug under observation and are monitored over time for either failure to clear parasites or for reappearance of parasites.
In vitro tests: In these tests, blood samples from malaria patients are obtained and the malaria parasites are exposed to different concentrations of antimalarial drugs in the laboratory. Some methods call for adaptation of parasites to culture first, while others put blood directly from patients into the test system.
Molecular characterization: For some drugs (chloroquine, SP and similar drugs, atovaquone), molecular markers have been identified that confer resistance. Molecular techniques, such as polymerase chain reaction (PCR) or gene sequencing can identify these markers in blood taken from malaria-infected patients.
For a general overview of drug resistance and methods for testing for drug resistance in malaria:
Drug Resistance In Malaria [PDF, 350 KB, 32 pages] (WHO, 2001)
For a detailed description of the in vivo methods:
Assessment And Monitoring of Antimalarial Drug Efficacy for The Treatment of Uncomplicated Falciparum Malaria [PDF, 471 KB, 68 pages] (WHO, 2003)
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