Residual Antimalarial Levels in Plasmodium Falciparum Malaria Patients from Selected Sites in India: An indication of Drug Pressure

Irrational treatment practices and selfmedication of antimalarials are common in malariaendemic areas. Such types of practices may affect the treatment outcome as well as could promote the spread of drug resistance in the community. The aim of the study was to monitor residual antimalarials level in Plasmodium falciparum infected patients belonging to Bilaspur and Betul districts in India. A total of 139 patients were enrolled for the treatment of antimalarials as per national treatment policy, and their clinical follow-up was done as per WHO guidelines (2009). Heparinised blood was taken on 31ET filter paper for monitoring residual antimalarials on day 0 and post-treatment sulphadoxine levels on day 7 using High Performance Liquid Chromatography, 27.3% of the patients showed residual antimalarials on day 0. Surprisingly, the residual levels did not correlated well with the information collected on case record forms. A significantly lower parasite density/μl of blood was observed in samples having residual antimalarials than the samples without residual antimalarials (P<0.05). The residual antimalarials detected in the blood might be due to previous drug episodes, self drug intake, and irrational treatment practices. Awareness towards rational treatment practices are the need of hour.