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Open AccessReview

Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug!

1
Department of Medicine, Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland
2
University of Basel, P.O. Box, CH-4003 Basel, Switzerland
Trop. Med. Infect. Dis. 2019, 4(1), 26; https://doi.org/10.3390/tropicalmed4010026
Received: 27 December 2018 / Revised: 30 January 2019 / Accepted: 30 January 2019 / Published: 1 February 2019
(This article belongs to the Special Issue Drug Resistance in the Malaria Parasite: Biology and Epidemiology)
Artemisinin-based combination therapies (ACTs) have become the mainstay for malaria treatment in almost all malaria endemic settings. Artemisinin derivatives are highly potent and fast acting antimalarials; but they have a short half-life and need to be combined with partner drugs with a longer half-life to clear the remaining parasites after a standard 3-day ACT regimen. When introduced, ACTs were highly efficacious and contributed to the steep decrease of malaria over the last decades. However, parasites with decreased susceptibility to artemisinins have emerged in the Greater Mekong Subregion (GMS), followed by ACTs’ failure, due to both decreased susceptibility to artemisinin and partner drug resistance. Therefore, there is an urgent need to strengthen and expand current resistance surveillance systems beyond the GMS to track the emergence or spread of artemisinin resistance. Great attention has been paid to the spread of artemisinin resistance over the last five years, since molecular markers of decreased susceptibility to artemisinin in the GMS have been discovered. However, resistance to partner drugs is critical, as ACTs can still be effective against parasites with decreased susceptibility to artemisinins, when the latter are combined with a highly efficacious partner drug. This review outlines the different mechanisms of resistance and molecular markers associated with resistance to partner drugs for the currently used ACTs. Strategies to improve surveillance and potential solutions to extend the useful therapeutic lifespan of the currently available malaria medicines are proposed. View Full-Text
Keywords: antimalarial; resistance; molecular marker; drug; surveillance; artemisinin; partner drug antimalarial; resistance; molecular marker; drug; surveillance; artemisinin; partner drug
MDPI and ACS Style

Nsanzabana, C. Resistance to Artemisinin Combination Therapies (ACTs): Do Not Forget the Partner Drug! Trop. Med. Infect. Dis. 2019, 4, 26.

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