What is the best treatment against malaria? Why combine drugs?

What is the best treatment against malaria? Why combine drugs?

From the World Health Organization (11 December 2009)

Malaria is caused by parasites. In most parts of the world, Plasmodium falciparum, the most lethal type of human malaria, has become resistant to conventional treatment. This is the use of a single drug (or monotherapy) of chloroquine, sulfadoxine-pyrimethamine, or another antimalarial medicine to fight malaria. WHO recommends that countries use a combination of antimalarial medicines to reduce the risk of drug resistance.

WHO recommends combinations that contain derivatives of artemisinin — a substance extracted from the plant Artemisia annua — along with another effective antimalarial drug.

These combinations are called artemisinin-based combination therapies (ACTs). ACTs are currently the most effective treatment for malaria, with a 95% cure rate against falciparum malaria.

Over the past five years, ACTs have been deployed on an increasingly large scale. ACTs produce a rapid clinical cure and are well tolerated by patients. In addition, ACTs have the potential to reduce transmission of malaria.

A total of 80 countries (45 of them in Africa) have officially adopted ACTs as their first line of treatment. Although 13 of these countries are not yet implementing this approach, most are deploying the medicines to a variable extent.

Plasmodium vivax malaria which is the second most common type of malaria also responds well to most ACTs. However, many countries continue to use chloroquine for its treatment because in most situations chloroquine is still effective against this parasite.

Malaria kills one million people and affects about 250 million people each year, mostly in Africa. Fighting malaria is a major public health imperative.

WHO urges pharmaceutical companies to stop marketing oral artemisinin-based medicines as monotherapies, which may promote artemisinin resistance. WHO recommends that companies market ACTs only.

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