Drug resistance hampers our capacity to roll back malaria.
Widespread drug resistance in parasites aggravates the burden of malaria. The extent of the problem is due mainly to the limited armamentarium of drugs used thus far to treat malaria and to policies and practices constrained by limited resources. All drugs in use are affected except, thus far, artemisinin derivatives. The scale and impact of resistance has been underestimated, leading to the continued use of failing drugs, which contributes to the rise in resistance and increased morbidity and mortality due to malaria. Pharmacological, epidemiological, and operational aspects factor the development and spread of resistance. Although the problem is complex, much can be done to reverse the course of events: adopt adequate tests to assess resistance, encourage and sustain development of new drugs, protect drugs against resistance through use of combinations, expand access to prompt and effective treatment, and promote evidence-based policies and sensible practices. The current situation favors the development of sensible strategies to restrain resistance.
Olliaro
Piero
P
United Nations International Children's Emergency Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme on Research and Training in Tropical Diseases, Geneva, Switzerland. olliarop@who.int
D000818:Animals; D000962:Antimalarials / Q000145:classification / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D037621:Artemisinins / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D004351:Drug Resistance / Q000235:genetics; D004359:Drug Therapy, Combination; D005493:Folic Acid Antagonists / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D005819:Genetic Markers; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000469:parasitology*; D009154:Mutation / Q000187:drug effects / Q000235:genetics; D021261:Parasitic Sensitivity Tests / Q000379:methods; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000472:pathogenicity; D011804:Quinolines / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D005493:Folic Acid Antagonists; D005819:Genetic Markers; D011804:Quinolines