Artemisinin-Based Combination Treatment of falciparum Malaria

Shoklo Malaria Research Unit, Mae Sot, Thailand.
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 11/2008; 77(6 Suppl):181-92.
Source: PubMed


Artemisinin-based combination treatments (ACTs) are now generally accepted as the best treatments for uncomplicated falciparum malaria. They are rapidly and reliably effective. Efficacy is determined by the drug partnering the artemisinin derivative and, for artesunate-mefloquine, artemether-lumefantrine, and dihydroartemisinin-piperaquine, this usually exceeds 95%. Artesunate-sulfadoxine-pyrimethamine and artesunate-amodiaquine are effective in some areas, but in other areas resistance to the partner precludes their use. There is still uncertainty over the safety of artemisinin derivatives in the first trimester of pregnancy, when they should not be used unless there are no effective alternatives. Otherwise, except for occasional hypersensitivity reactions, the artemisinin derivatives are safe and remarkably well tolerated. The adverse effect profiles of the artemisinin-based combination treatments are determined by the partner drug. Most malaria endemic countries have now adopted artemisinin-based combination treatments as first-line treatment of falciparum malaria, but in most of these only a minority of the patients that need artemisinin-based combination treatments actually receive them.

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    • "Author(s) agree that this article remains permanently open access under the terms of the Creative Commons Attribution License 4.0 International License (Nosten and White, 2007). Since the adoption of the ACT policy in many regions where P. falciparum malaria is endemic (Bosman and Mendis, 2007), a trend of steady reduction in global malaria incidence has been observed (WHO, 2011). "

    AFRICAN JOURNAL OF BIOTECHNOLOGY 01/2015; 14(4):304-309. DOI:10.5897/AJB2014.13942 · 0.57 Impact Factor
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    • "The relatively high cost of these antimalarials has made their manufacture a lucrative venture for pharmaceutical industries; a situation that has led to the proliferation of diverse brands on the market. This has led some unscrupulous people to indulge in the manufacture of substandard and falsified brands [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. The WHO acknowledges the difficulty that this situation presents to the quality assurance of antimalarials on the market, especially in developing countries where enforcement of laws regarding manufacture, importation , and distribution of medicines is relatively lax. "
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    ABSTRACT: This study, conducted as part of our overall goal of regular pharmacovigilance of antimalarial medicines, reports on the quality of 132 artemisinin-based antimalarial medicines distributed in Ghana and Togo. Three methods were employed in the quality evaluation-basic (colorimetric) tests for establishing the identity of the requisite active pharmaceutical ingredients (APIs), semi-quantitative TLC assay for the identification and estimation of API content, and HPLC assay for a more accurate quantification of API content. From the basic tests, only one sample totally lacked API. The HPLC assay, however, showed that 83.7% of the ACTs and 57.9% of the artemisinin-based monotherapies failed to comply with international pharmacopoeia requirements due to insufficient API content. In most of the ACTs, the artemisinin component was usually the insufficient API. Generally, there was a good correlation between the HPLC and SQ-TLC assays. The overall failure rates for both locally manufactured (77.3%) and imported medicines (77.5%) were comparable. Similarly the unregistered medicines recorded a slightly higher overall failure rate (84.7%) than registered medicines (70.8%). Only two instances of possible cross-border exchange of medicines were observed and there was little difference between the medicine quality of collections from border towns and those from inland parts of both countries.
    Malaria Research and Treatment 10/2014; 2014:806416. DOI:10.1155/2014/806416
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    • "In response to resistance, artemisinin-based combination therapies (ACTs), that combines a semi-synthetic derivative of artemisinin, with a partner drug of a distinct chemical class, has been adopted for the treatment of falciparum malaria to delay the development of resistance (Nosten and White, 2007; Eastman, et al., 2005; WHO, 2003). However, there is a considerable concern that this will otherwise not happen. "

    08/2014; 8(6):111-117. DOI:10.5897/AJBR2014.0780
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