1. Drug Resistance Monitoring in Cambodia 1997 - 2003

2. Sensitivity (S or S/RI) at 4 sentinel sites 1991 – 97 Western areas: Battambang, Pursat, Eastern areas:Ratanakiri, Kratie  Chloroquine - 1991-93 (West): S or S/RI = 3-12% -1997 (East): S/RI = 76%-86%  Fansidar® -1991-95 (West): S or S/RI = 0-13% -1991-95 (East): S or S/RI = 57-80%  Quinine and Tetracycline -1994-95 (All areas):S/RI = 100 %  Mefloquine monotherapy: -1991-97 (West): S or S/RI = 80%-97% -1992-97 (East): S or S/RI = 100%

3. Drug Resistance Monitoring in Cambodia 1998  No study  Lack of budget  Lack of human resources due to Dengue due to Dengue epidemic outbreak

4. Mefloquine25mg Drug Resistance of Chloroquine & Mefloquine Monotherapy 1999 Sampov Loun Rovieng Mefloquine25mg Chloroquine Mefloquine25mg/kgw

5. Drug Resistance Artecom in Cambodia 1999 Sampov Loun snoul Artecom(Art.+piperaq.+trimetho prime) 2days,28days follow up

6. Drug Resistance of A+M in Cambodia 2000 Sampov Loun Oral,Kg Speu

7. Samlot Snoul Drug Resistance of A+M Monitoring2001

8. Drug Resistance of Artekine 2 & Coarterm 2001 Anlong Veng Artekine2 42 3 Artekine2 56 5 Coarterm 38 15

9. N=82 Drug Resistance Monitoring A+M in Cambodia 2002 N=36 N=75 Preah Vihear Pailin Veal Veng Ratanakiri Snoul

10. Drug Resistance of Artekine 2 & Coarterm in Cambodia 2002 Sampov Loun Snoul Coarterm N=55 N=65 Artekine 2.

11. Drug Resistance Monitoring A+M in Cambodia 2003 Name of sites No. of enrollment Drop outACPRLTF Oral97 (64.7%) 06 (6.2%) 88 (96.7%) 03 a (3.3%) Anlong Veng 92 (61%) 02 (2.2%) 88 (97.8%) 02 b (2.2%) Snoul66 (41.8%) 03 (4.5%) 63 (100%) 0 Sampov loun 55 (21%) 03 (5.5%) 48 (92.7%) 4 c (7.3%) a = PCR confirmed all cases are recrudescing b = Showed that both are re – infection c = PCR confirmed all cases are recrudescing PCR were done by Institute Pasteur of Cambodia

12. Drug Resistance Monitoring at sentinel sites, Cambodia 2002 & 2003 YearName of sitesNo. of enrollment ACPR (%)LTF (%) 2002Pailin828812 2002Pursat88946 2002Prah vihear36973 2002Rattanakiri751000 2003Battambang5592.77.7 2003Kg. Speu9796.73.3 2003Kratie661000 2003O. M. Chey9297.82.2

13. Sentinel sites of drug resistance monitoring in Cambodia

14. Conclusion The result showed the sensitivity of A+M still high (ACPR = 92 – 100%) each sentinel site if we compared to the result of previous study. So The A+M can be continue as drug for our first line treatment of malaria.

15. Test system Days01237142128Othe r day Clinical examinationXXXXXXXXX Axillary TemperatureXXXXXXXXX Treatment A+M A=12mg/kg, for 3days M=25mg/kg on day0 X A+M XAXA XAXA ParasitemiaXXXXXXXXX Blood spot (PCR) Blood sampling ( For In Vitro test) XXXX XXX

16. Thank you for your attention