Antimalarial drug resistance is nowgenerally approved to be one of the considerable risk to our ability to ‘Rollback malaria’. The situation is getting worse; with the growing frequency and risingdrug resistance (Yeunget al., 2004).Conditions are not different in Pakistan and falciparum malaria is on the progress(Nizamani et al.
, 2006). Chloroquin resistant plasmodiumfalciparum malaria now prevail in South America, Southeast Asia, and parts of Africa.Resistance to sulphadoxine-pyrimethamine is common in South America, Asia and andis spred out in Africa and even quinine has become less efficient over time (Yeung et al., 2004).
In a moment falciparum malaria accounts for 18% to 62% ofall cases of malaria in different zones of Pakistan with resistance to one ormore antimalarials reaching up to 40% (Khan et al., 2004). Resistance offalciparum malaria to chloroquin is broadly expand in Pakistan and it is no longersupported (Shah et al., 1997; Rana et al., 2004).
Recently use of antimalarials incombination with other antibiotics has been promoted in many countries (Khan et al., 2004). ). Quinine is the drug of choice for P. falciparumbut irregular cases of resistant strains are being recorded with monotherapy (Jamal et al., 2005;Bhalli et al.
,2001;).Artimisinin derivatives are currently useful but are expensive for a developingcountry to be used on a mass scale (Laxminarayan etal., 2004). The target are twofold: to manage synergisticor additive killing of parasites, and to prevent development of drug resistance.Quinine has been used in combination with , azithromycin, doxycycline, clindamycin(Alecrim et al., 2006 ; Miller et al.,2006).
All have been recorded to be efficient.There is insufficiency of description in Pakistani medical literature representingthe use of quinine based combination therapy. However it has been recommendedin the guidelines of treatment of falciparum malaria (Khanet al., 2004).