To beat resistance to antimalarials switch to combination medicines
An estimated 800 000 children die of malaria each year, and this number may be rising because of drug resistance. WHO is urging countries to switch to a new type of combination therapy based on artemisinin wherever there is strong evidence that conventional treatment is not working. The cheapest and most readily available antmalarials are becoming ineffective in many parts of Africa. The new artemisinin-based combination therapies (ACTs) kill the parasite quickly, enabling the patient to recover with very few side-effects. One of these combinations - of artemether and lumefantrine - has just been added to WHO's Essential Medicines List. Known as Coartem, it provides an artemisinin and a non-artemisinin compound in a single tablet. WHO also recommends other combinations of artemisinin compounds with medicines currently being used such as amodiaquine or sulfadoxine-pyrimethamine, where these are still effective.
For decades, chloroquine has been the best-known treatment for malaria and it has saved millions of lives. However, the malaria parasite has become increasingly resistant to it in recent years, especially in eastern, central and southern Africa. As a result, many countries have switched to sulfadoxine-pyrimethamine, known as SP or Fansidar, but resistance to SP is also spreading. WHO recommends that countries start changing over to ACTs when resistance levels exceed 15%. More information from Iain Simpson, Communicable Diseases, email: firstname.lastname@example.org.