Declining artesunate-mefloquine efficacy against falciparum malaria on the Cambodia-Thailand border.
Resistance to many antimalaria drugs developed on the Cambodia-Thailand border long before developing elsewhere. Because antimalaria resistance is now a global problem, artemisinin-based combination therapies (ACTs) are the first-line therapies in most malaria-endemic countries. However, recent clinical and molecular studies suggest the emergence of ACT-resistant Plasmodium falciparum infections in the Cambodia-Thailand border area, where standard ACT is artesunate and mefloquine. These ACT failures might be caused by high-level mefloquine resistance because mefloquine was used for monotherapy long before the introduction of ACT. This observation raises 2 questions. First, how can existing P. falciparum-resistant strains be controlled? Second, how can the evolution of new ACT- resistant strains be avoided elsewhere, e.g., in Africa? Enforcement of rational drug use and improved diagnostic capacity are among the measures needed to avoid and contain ACT resistance.
Wongsrichanalai
Chansuda
C
US Naval Medical Research Unit No. 2, Jakarta, Indonesia. cwongsrichanalai@usaid.gov
Meshnick
Steven R
SR
D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D037621:Artemisinins / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D002160:Cambodia / Q000453:epidemiology; D023801:Directly Observed Therapy; D004351:Drug Resistance / Q000235:genetics; D004359:Drug Therapy, Combination; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D015767:Mefloquine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics; D016133:Polymerase Chain Reaction; D013785:Thailand / Q000453:epidemiology; D017211:Treatment Failure
D000962:Antimalarials; D037621:Artemisinins; D015767:Mefloquine