Malaria is an overwhelming problem in developing countries, and chloroquine resistance is now widespread among P. falciparum in sub-Saharan Africa, Asia, and Latin America. Although decreased quinine sensitivity has been observed in some malaria parasites, the spread of quinine resistance across the world has been very slow and quinine still remains an effective drug in the treatment of severe infections. In the United States, the treatment of choice for falciparum malaria in adults is a combination of intravenous quinidine plus oral doxycycline. Persistent liver stages of P. vivax may cause relapse after the initial course of treatment but can be eradicated with primaquine. Duffy antigen is the erythrocyte receptor for P. vivax merozoite invasion. Duffy antigen negativity, which is very prevalent in West Africa, accounts for the low incidence of vivax malaria in this region.
- Widespread quinine resistance is a significant problem in African countries.
Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennetts principles and practice of infectious diseases. 6th ed. New York: Elsevier/Churchill Livingstone; 2005.
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