Global resistance surveillance: ensuring antimalarial efficacy in the future.
OBJECTIVE
Effective surveillance for and rapid identification of evolved antimalarial resistance ensures that all patients are treated with efficacious drugs. This review summarizes the current status and the challenges to effective surveillance, and suggests approaches for improvement.


RESULTS
The replacement of older drugs by artemisinin combination therapies (ACTs) as the recommended treatment for malaria has dramatically improved treatment outcomes wherever ACTs have been deployed effectively. Moreover, there has been considerable technical and organizational progress, and support for the health professionals needed to carry out this work is also increasing. As a result, the prospects for more effective surveillance of antimalarial resistance, and other vital health information are improving. However, resistance to the artemisinin component of ACTs is already suspected in Cambodia, and the current methods for tracking this resistance are not yet in place. Identification of efficient markers of ACT efficacy is a crucial challenge.


CONCLUSIONS
Technical advances alone are not sufficient. Detection of decreased drug efficacy is only the first step to producing accessible and useful information for decision makers. The translation of increased access to data on health outcomes into usable evidence for rational policy and planning requires a global coordination and communication effort.
Guerin
Philippe J
PJ
WorldWide Antimalarial Resistance Network (WWARN), UK. philippe.guerin@wwarn.org
Bates
Sarah J
SJ
Sibley
Carol H
CH
D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use; D004338:Drug Combinations; D004351:Drug Resistance; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D011159:Population Surveillance; D013997:Time Factors; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C031327:artemisinin