1. Sayed Ali Mus POST GRADUATES-BATCH 6 FACULTY OF MEDICAL LABORATORY SCIENCES PARASITOLOGY DEPARTMENT ALNEELIN UNIVERSITY March 2015 Symposium on: Advances in Parasitology “Education and Research in Parasitology in the service of Mankind “

2. Introduction Malaria occurs in over 90 countries worldwide (WHO) Malaria transmission occurs primarily in tropical and subtropical regions in sub-Saharan Africa, Central and South America (WHO)

3. Definition of Antimalarial drug resistance “ ability of a parasite strain to survive and/or multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended but within tolerance of the subject.

4. Drug Targets

5. influence of the development of antimalarial drug resistance The degree of resistance conferred by the genetic change  The‘ fitness cost’ of the resistance mechanism  The number of the parasites exposed to the drug

6. Mechanisms of antimalarial resistance In order to appropriate the physical nature of resistance, it is necessary to look in more details at the metabolism of the parasite and the mode of action of the antimalarial drugs

7. Mechanisms of antimalarial resistance In general, resistance appears to occur through spontaneous mutations that confer reduced sensitivity to a given drug or class of drugs. For some drugs, only a single point mutation is required to confer resistance, while for other drugs, multiple mutations appear to be required.

8. Importance of monitoring of resistance  Without regular monitoring and reporting of antimalarial drug resistance  The disease burden and the economic costs of malaria will rise dramatically

9. Monitoring drug efficacy Clinical and parasitological monitoring 28 – 42 days follow up WHO protocol Treatment out come

10. Procedure blood films will be taken on day 0, 2,3,7,14,21 and day 28 Blood flim shuld be stained & examined immediately and counted the parasite (!!) Also after taken thick film take sample on filter paper except day 2 & day 3. slide and filter should be labeled

11. Molecular techniques

12. Treatment failure  not all treatment failure is due to drug resistance. Many factors can contribute to treatment failure including:  incorrect dosing,  non-compliance with duration of dosing regimen,  poor drug quality  drug interactions,  poor or erratic absorption, and pharmacokinetics pharmacodynamics of the antimalarial medicine;

13. Challenges to monitoring antimalarial drug efficacy According to the WHO standard protocol (WHO, 2009) the efficacy of first- and second-line medicines should be tested at least once every 24 months at all sentinel sites

14. Challenges to monitoring antimalarial drug efficacy The sentinel sites should represent all epidemiological strata in a country. In addition, monitoring should be conducted at the same sentinel sites over time in order to allow analysis of trends. Currently, few countries are conducting an adequate number of studies.

15. Challenges to monitoring antimalarial drug efficacy  As transmission rates and malaria incidence decline in low-transmission areas,  It has become more difficult to find patients who meet the inclusion criteria

16. The future:prevention of drug resistance Urgent efforts are needed to identify effective, affordable, alternative antimalarial for the management of multidrug resistant malaria, use of antimalarial drugs in combination may be helpful requires reducing the overall drug pressure through more selective use of drugs and improving

17. The future:prevention of drug resistance Education of the practitioners 2. Increase compliance by users of ACTs /SP 3. Better diagnosis of the disease to avoid misuse of the medicines

18. Thank you ?