In the past twenty years, the use of artemisinin, particularly in combination with other anti-malarials, so called Artemisinin Combination Therapy (ACT), has been the major contributor to a reduction in world malaria deaths from one million to 627,000 (2012). It has been disconcerting, then, to see the development of artemisinin resistant falciparum malaria in rural SE Asia, with the prediction of eventual spread to other parts of the world.
Laboratory testing for artemisinin resistance is both laborious and expensive. Fortunately a practical method had been developed in the field which uses the rate of clearing of parasites from the patient’s bloodstream as a measure of resistance. Thankfully, resistant falciparum can be treated successfully using a seven day course instead of the usual 3 days.
The authors of a recent editorial in the New England Journal of Medicine recommend:
1. Increased surveillance for the spread of resistance to new areas
2. Encouraging development of new antimalarial drugs, which are certain to be needed in the near future.
3. Support for the development and implementation of an effective malaria vaccine.
Ref: Treatment of Malaria, a Continuing Challenge. NEJM 2014;371: 474-75. July 31, 2014
Submitted by Roger W. Boe MD.