A systematic review of CQ-resistant Plasmodium vivax malaria infections in India

Introduction: Chloroquine (CQ) is the drug of choice for treating uncomplicated Plasmodium vivax (P.vivax) malaria in India. The knowledge about the exact burden of CQ resistance in P. vivax in India is scarce. Therefore, this systematic review aimed to assess the prevalence of CQ resistance in reported P.vivax cases from India. Methods: PubMed, EMBASE, and Web of Science, were searched using the search string: ‘Malaria AND vivax AND chloroquine AND (resistance OR resistant) AND India’. We systematically reviewed in-vivo and in-vitro drug efficacy studies that investigated the CQ efficacy of P. vivax malaria between January 1995 and December 2022. Those studies where patients were followed up for at least 28 days after initiation of treatment were included. Results: We identified 12 eligible CQ therapeutic efficacy studies involving 2470 patients, Of these 2329 patients were assessed by in-vivo therapeutic efficacy methods and the remaining 141 were assessed by in-vitro methods. CQ resistance was found in 25/1787 (1.39%) patients from in-vivo and in 11/141 (7.8%) patients from in-vitro drug efficacy studies. Conclusion: Based on the available studies, the prevalence of CQ resistance in P.vivax was found to be relatively lower in India. However, continued surveillance and monitoring are crucial to identify the emergence of CQ resistance.