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Does antimalarial mass drug administration increase or decrease the risk of resistance?

Nicholas J White1

  • 1Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

The Lancet. Infectious Diseases
|November 15, 2016
PubMed

Insights

Mass drug administration (MDA) for malaria can reduce drug resistance by targeting symptomatic infections. Effective treatment lowers parasite numbers and transmission, mitigating resistance emergence in populations.

Area of Science:

  • Malariology
  • Infectious Disease Epidemiology
  • Drug Resistance Studies

Background:

  • Antimalarial drug resistance is a persistent challenge, leading to treatment failures.
  • Mass drug administration (MDA) is often perceived as a primary driver of antimalarial drug resistance.
  • Understanding the dynamics of resistance emergence is crucial for effective malaria control.

Purpose of the Study:

  • To analyze the conditions under which antimalarial MDA influences the risk of drug resistance.
  • To differentiate the impact of parasite burden versus population exposure on resistance.
  • To inform strategies for mitigating antimalarial drug resistance.

Main Methods:

  • Conceptual analysis of parasite survival and spread dynamics.
  • Evaluation of asymptomatic versus symptomatic malaria infections.
  • Review of factors influencing resistance emergence in malaria-endemic regions.

Main Results:

  • Resistance risk is determined by the total number of parasites and their survival/spread probability, not solely by the number of people treated.
  • Symptomatic malaria cases with high parasite loads are the primary source for resistance emergence.
  • Asymptomatic infections, while common, harbor lower parasite burdens and are less likely to drive resistance.

Conclusions:

  • Antimalarial MDA can decrease resistance risk if it effectively reduces symptomatic cases and overall transmission.
  • Targeted mass treatment strategies focusing on high-parasite-burden infections are key.
  • Reducing transmission through effective treatment is a viable approach to combat antimalarial drug resistance.

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