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Artemisinin-based combination therapies for uncomplicated malaria.

Timothy M E Davis¹, Harin A Karunajeewa, Kenneth F Ilett

¹Medicine Unit, School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, WA. tdavis@cyllene.uwa.edu.au

The Medical Journal of Australia

|February 22, 2005

Summary

Artemisinin-based combination therapies (ACTs) combat malaria drug resistance. Dihydroartemisinin-piperaquine shows promise as a potent, safe, and affordable ACT option.

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Area of Science:

Tropical medicine
Infectious diseases
Pharmacology

Background:

Increasing resistance to conventional antimalarial drugs necessitates new treatment strategies.
Artemisinin-based combination therapies (ACTs) are WHO-recommended for Plasmodium falciparum malaria.
ACTs combine a fast-acting artemisinin derivative with a longer-acting partner drug.

Purpose of the Study:

To review the efficacy and tolerability of various artemisinin-based combination therapies (ACTs).
To identify optimal ACTs for combating malaria drug resistance.
To explore future directions in ACT development.

Main Methods:

Review of existing literature on ACTs.
Comparative analysis of different artemisinin derivatives and partner drugs.

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Evaluation of efficacy, safety, cost, and administration factors.

Main Results:

Artesunate-mefloquine is effective but costly and has neurotoxic side effects.
Artemether-lumefantrine has variable efficacy and requires co-administration with food.
Dihydroartemisinin-piperaquine demonstrates high efficacy, good tolerability, and affordability.

Conclusions:

Dihydroartemisinin-piperaquine represents a highly effective and well-tolerated ACT.
Future ACTs may involve trioxolanes and novel partner drugs like pyronaridine or naphthoquine.
The development of potent, safe, and inexpensive ACTs remains a priority in malaria treatment.