Presumptive artemether resistance in a patient with mixed malarial infection.

In India, the first confirmed report of chloroquine resistance in P. falciparum was reported in 1973. Since then there has been a rise in resistance to chloroquine in Plasmodium falciparum and vivax as also to pyrimethamine sulphadoxine group of drugs. Resistance to artemisinin and its derivatives has not been documented in India except for isolated case reports. In a multicentric study of arteether in patients of uncomplicated falciparum malaria, it was found that the cure rate was 97% with fever clearance time between 24 168 hrs, and parasite clearance time between 24-72 hours. Our patient remained febrile and malarial parasites persisted on peripheral smear even after 144 hours of treatment of artemether. The response came only after administration of mefloquine. We conclude that, this patient had infection with P. falciparum that was resistant to chloroquine and artemether.