Patient was given chloroquine & doxycycline for 7 days. Patient's fever decreases in 4 days but, peripheral smear showed occasional gametocytes of plasmodium falciparum. This type of drug resistance is -

Ans. is 'b' i.e., R2 type WHO classification of antimalarial drug resistance 1. S-sensitive --) If a sexual parasites have cleared by day 6 from the begining of treatment wihout subsequent recrudescence until day 28. 2. R1-Low grade resistance --> Recrudescence of infection between 7-28 days of completing treatment. 3. R2-High grade resistance --> Reduction of parasitemia by more than 75% at 48 hours of completing treatment but failure to clear the organism within 7 days. 4. R3-->Parasitemia does not fall by more than 75% within 48 hours of compleing treatment and there is no subsequent clearance of asexual parasites. Following information has been added in 22deg/e of Park Treatment o After treatment patient is considered cured it he/she does not have fever or parasitaemia till 28th day. Some patient may not respond to treatment (especially in falciparum malaria), due to treatment failure : -I) Early treatment failure (ETF) : - If any of the following occurs : - i) Development of danger signs or severe malaria on day 1, 2 or 3, in the presence of parasitaemia. ii) Parasitaemia on day 2 higher than day zero. iii) Parasitaemia on day 3 with either (i) Axillary temperature > 37.5degC or (ii) > 25% count on day zero. 2) Late clinical failure (LCF) : - It includes : - i) Development of danger signs or severe malaria with parasitaemia between day 4 and day 28. Presence of parasitaemia in 4-28 days with axillary temperature > 37.5degC. 3) Late parasitological failure (LPF): - Presence of parasitaemia between 7-28 days with axillary temperature < 37.5degC.