title: Ivermectin to reduce malaria transmission: a research agenda for a promising new tool for elimination.
abstract: BACKGROUND
  The heterogeneity of malaria transmission makes widespread elimination a difficult goal to achieve. Most of the current vector control measures insufficiently target outdoor transmission. Also, insecticide resistance threatens to diminish the efficacy of the most prevalent measures, indoor residual spray and insecticide treated nets. Innovative approaches are needed. The use of endectocides, such as ivermectin, could be an important new addition to the toolbox of anti-malarial measures. Ivermectin effectively targets outdoor transmission, has a novel mechanism of action that could circumvent resistance and might be distributed over the channels already in place for the control of onchocerciasis and lymphatic filariasis.
  
  
  METHODS
  The previous works involving ivermectin and Anopheles vectors are reviewed and summarized. A review of ivermectin's safety profile is also provided. Finally three definitive clinical trials are described in detail and proposed as the evidence needed for implementation. Several smaller and specific supportive studies are also proposed.
  
  
  CONCLUSIONS
  The use of ivermectin solves many challenges identified for future vector control strategies. It is an effective and safe endectocide that was approved for human use more than 25 years ago. Recent studies suggest it might become an effective and complementary strategy in malaria elimination and eradication efforts; however, intensive research will be needed to make this a reality.
authors: Internal Medicine Department, Clínica Universidad de Navarra, Av, Pio XII 36, Pamplona 31008, Spain. cchaccour@unav.es
authors: Carlos J
authors: CJ
authors: Chaccour
authors: Kevin C
authors: KC
authors: Kobylinski
authors: Quique
authors: Q
authors: Bassat
authors: Teun
authors: T
authors: Bousema
authors: Chris
authors: C
authors: Drakeley
authors: Pedro
authors: P
authors: Alonso
authors: Brian D
authors: BD
authors: Foy
mesh_terms: D000818:Animals; D000852:Anopheles / Q000187:drug effects*; D000977:Antiparasitic Agents / Q000494:pharmacology / Q000600:supply & distribution*; D002986:Clinical Trials as Topic; D006801:Humans; D007306:Insecticides / Q000494:pharmacology / Q000600:supply & distribution*; D007559:Ivermectin / Q000494:pharmacology / Q000600:supply & distribution*; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission*; D009032:Mosquito Control / Q000379:methods*
chemical_list: D000977:Antiparasitic Agents; D007306:Insecticides; D007559:Ivermectin
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