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Artemisinin‐based combination therapies for uncomplicated malaria
Author(s) -
Davis Timothy M E,
Karunajeewa Harin A,
Ilett Kenneth F
Publication year - 2005
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2005.tb06650.x
Subject(s) - mefloquine , artemisinin , artesunate , artemether , lumefantrine , piperaquine , malaria , dihydroartemisinin , medicine , pharmacology , chloroquine , plasmodium falciparum , combination therapy , immunology
There has been a relentless increase in resistance of malaria parasites to conventional antimalarial drugs, including chloroquine, sulfadoxine–pyrimethamine and mefloquine. In response to this situation, short‐course artemisinin‐based combination therapies (ACTs) have been developed. The World Health Organization has endorsed ACT as first‐line treatment where the potentially life‐threatening parasite Plasmodium falciparum is the predominant infecting species. ACTs combine the rapid schizontocidal activity of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a longer‐half‐life partner drug. Although the use of chloroquine and sulfadoxine–pyrimethamine as partners in ACT improves their efficacy, this may only have value as a short‐term measure in patients with a degree of immunity to malaria. Alternative currently available partner drugs include mefloquine, lumefantrine and piperaquine. Artesunate–mefloquine is highly effective but is expensive and side effects (mainly neurotoxicity) can be problematic. Artemether–lumefantrine, the only ACT available in Australia, appears less effective than artesunate–mefloquine and needs to be administered with food to ensure adequate bioavailability. Dihydroartemisinin–piperaquine is highly effective, well tolerated and relatively inexpensive. The goal of potent, safe, easy‐to‐administer and inexpensive ACTs may see trioxolanes in place of artemisinin derivatives, as well as novel partner drugs such as pyronaridine or naphthoquine, in the future.