title: Evolution from double to triple-antimalarial drug combinations.
abstract: Drug combinations are used to treat multiple-drug resistant malaria parasites and to attempt to further delay the evolution of drug resistance. Most current antimalarial combinations are binary but it is likely that new triple drug combinations will be required in the future. A review of previous triple combinations of antimalarial drugs was done to focus attention on past problems and possible future combinations. The advantages of such triple drug combinations include greater efficacy against multiple-drug resistant strains, synergistic action between the different medications and simplification of the regimen so that it could be administered under direct observation and possibly as single-dose therapy. The disadvantages of poly-pharmacy include increased cost of medication, difficulty preparing robust regulatory packages and problems constructing combined formulations due to drug-drug interactions. Given the arrival of artemisinin tolerance/resistance in Southeast Asia, it is likely that new drugs introduced for malaria treatment will be in triple drug combinations.
authors.affiliation: Australian Army Malaria Institute, Enoggera, QLD 4051, Australia School of Population Health, University of Queensland, Brisbane, Australia dennis.shanks@defence.gov.au.
authors.forename: G Dennis
authors.initials: GD
authors.lastname: Shanks
authors.affiliation: Australian Army Malaria Institute, Enoggera, QLD 4051, Australia School of Population Health, University of Queensland, Brisbane, Australia.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Edstein
authors.affiliation: Jacobus Pharmaceutical Company Inc., Princeton, New Jersey, USA.
authors.forename: David
authors.initials: D
authors.lastname: Jacobus
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control; D011804:Quinolines / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines
keywords: Antimalarial drugs; Chemotherapy; Combination drug therapy; Malaria