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Artemisinin Resistance Can Be Defeated By Drug Combinations

Publish Date 2020-04-08
The artemisinin group of antimalarial drugs has proven its effectiveness and efficiency in the treatment of this devastating disease spread over incredibly large territories all over the world. Artemisinins have shown numerous beneficial effects on human health. For example, the powerful anti-cancer properties are still being actively studied with some very promising results.

However, the application of the drug by itself (monotherapy) is discouraged by the World Health Organization, following the signs that malarial parasites are getting adapted - developing resistance to the drug. It is recommended that therapies with combinations of artemisinin with other antimalarial drugs are preferred as a treatment for malaria. Some of those artemisinin-based combination therapies indicated by the WHO are: artesunate-mefloquine, artemether-lumefantrine, artesunate-amodiaquine, and dihydroartemisinin-piperaquine. They are found to be highly efficacious, and have been officially listed as first-line therapies for uncomplicated malaria in most countries where malaria is considered endemic.

Evidence of artemisinin resistance southeast Asia was first reported in 2008, and later confirmed by studies in western Cambodia. In 2011, the WHO stated that the highly undesirable resistance to the reportedly most effective antimalarial agent, artemisinin, could unravel malaria control programs in India. Unfortunately, resistance continued its spread and in 2012 was reported also in the neighboring Thailand.

Urgent containment efforts have been made and are still underway in the affected countries in all areas with suspected or confirmed artemisinin resistance. A high-level malaria summit was held in 2012 in Sydney, Australia.

A document with a critical importance was adopted:"Consensus on malaria control and elimination in the Asia-Pacific", followed by the adoption of the "Declaration of the 7th East Asia Summit on Regional Responses to Malaria Control and Addressing Resistance to Antimalarial Medicines", signed in Cambodia (2012), and the conduction of the East Asia Summit, focusing on the topic, in Brunei Darussalam in October 2013. Additional resources and efforts are needed to identify and fully implement the recommendations in the endemic countries outside this region, especially in Africa, where malaria took 560 000 lives in 2012.

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