Malaria treatment and drug resistance

The malaria parasite is capable of becoming resistant to the action of anti-malaria drugs. This is due to small changes in the parasite DNA (point mutations). Over-prescription of anti-malarials (confusion with other febrile diseases) and the uncontrolled selling of poor quality drugs contribute to the increase in drug resistant parasites.

The widespread and increasing occurrence of P. falciparum resistant against affordable anti-malarial drugs, such as chloroquine (CQ) and sulphadoxine-pyrimethamine (SP) is more and more hampering the fight against malaria. CQ and SP are still the most widely used drugs for treatment in most of Africa, because of low cost and availability. However, when more than 30% of treatments fail, as is the case in many parts of Africa, change to another first-line treatment is recommended. At present, the World Health Organisation recommends that all countries experiencing resistance to conventional mono-therapies, such as chloroquine or sulfadoxine-pyrimethamine, should use combination therapies, preferably artemisinin-based combination therapies (ACTs) for P. falciparum malaria. Artemisinin-based combination therapy (ACT) uses a combination of anti-malaria drugs, one of which is an artemisinin derivative (e.g. artesunate, artemether or dihydroartemisinin). Artemisinin can be extracted from a plant, A. annua. Under the name ‘Qinghaosu’, it has been used in traditional Chinese medicine to treat fever for over 2000 years.