[Imported malaria: safer and more efficacious drugs?]

Area of Science:

• Tropical medicine
• Infectious diseases
• Pharmacology

Background:

• Antimalarial drug resistance necessitates new treatment strategies.
• Artemisinin-based combination therapies (ACTs) are crucial for malaria control.
• Parasite resistance to older antimalarials has driven the adoption of ACTs.

Observation:

• Decreased parasite susceptibility to artemisinin noted in Southeast Asia.
• Artemether-lumefantrine demonstrates high efficacy and safety for Plasmodium falciparum and P. vivax.
• Intravenous artesunate significantly reduces mortality in severe malaria compared to quinine.

Findings:

• ACTs have enhanced patient survival and reduced malaria transmission globally.
• Current artemisinin resistance in Southeast Asia does not impact uncomplicated malaria treatment for travelers.
• Artemether-lumefantrine remains a highly effective and safe treatment option.
• Intravenous artesunate offers a significant survival advantage for severe malaria patients.

Implications:

• Continued use of artemether-lumefantrine is recommended for uncomplicated malaria.
• Intravenous artesunate is a vital treatment for severe malaria, requiring careful hematological monitoring in travelers.
• Ongoing surveillance for antimalarial drug resistance is essential for public health.