Combination therapy in light of emerging artemisinin resistance

Abstract

Within less than a decade virtually all malaria-endemic countries have adopted one of the WHO-recommended artemisinin-based combination therapies (ACTs) for the treatment of falciparum malaria. In 2006, the first cases of clinical artemisinin resistance were reported from the Thai-Cambodian border. A number of factors are likely to have contributed to the development of artemisinin resistance in Southeast Asia. However, current evidence suggests that artemisinin resistance is simply a natural consequence of the massive deployment of ACTs in the region. The potentially devastating implications of resistance to a drug class to which there is currently no real alternative call for cost-effective strategies to extend the useful life spans of currently available antimalarial drugs. At the same time, major efforts to develop novel combination therapies not based on artemisinins are required.