Rational deployment of antimalarial drugs in Africa: Ahould first-line combination drugs be reserved for paediatric malaria cases?

Colin J. Sutherland*, Hamza Babiker, Margaret J. MacKinnon, Lisa Ranford-Cartwright, Badria Babiker E.L. Sayed

*المؤلف المقابل لهذا العمل

نتاج البحث: المساهمة في مجلةArticleمراجعة النظراء

13 اقتباسات (Scopus)

ملخص

Artemisinin-based combination therapy is exerting novel selective pressure upon populations of Plasmodium falciparum across Africa. Levels of resistance to non-artemisinin partner drugs differ among parasite populations, and so the artemisinins are not uniformly protected from developing resistance, already present in South East Asia. Here, we consider strategies for prolonging the period of high level efficacy of combination therapy for two particular endemicities common in Africa. Under high intensity transmission, two alternating first-line combinations, ideally with antagonistic selective effects on the parasite genome, are advocated for paediatric malaria cases. This leaves second-line and other therapies for adult cases, and for intermittent preventive therapy. The drug portfolio would be selected to protect the "premier" combination regimen from selection for resistance, while maximising impact on severe disease and mortality in children. In endemic areas subject to low, seasonal transmission of Plasmodium falciparum, such a strategy may deliver little benefit, as children represent a minority of cases. Nevertheless, the deployment of other drug-based interventions in low transmission and highly seasonal areas, such as mass drug administration aimed to interrupt malaria transmission, or intermittent preventive therapy, does provide an opportunity to diversify drug pressure. We thus propose an integrated approach to drug deployment, which minimises direct selective pressure on parasite populations from any one drug component. This approach is suitable for qualitatively and quantitatively different burdens of malaria, and should be supported by a programme of routine surveillance for emerging resistance.

اللغة الأصليةEnglish
الصفحات (من إلى)1459-1468
عدد الصفحات10
دوريةParasitology
مستوى الصوت138
رقم الإصدار12
المعرِّفات الرقمية للأشياء
حالة النشرPublished - أكتوبر 2011

ASJC Scopus subject areas

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