Malaria-Resistant Drugs

What will happen if the current treatment for malaria continues to be less effective in the next few years? What will be the ripple effect in Asia, Africa (the two continents most plagued by malaria), and the rest of the world? Resistance of Plasmodium falciparum to choloroquine, the cheapest and the most used drug is spreading in almost all the endemic countries.

Here is an alarming report of increasing resistance in the Thailand-Cambodia area

And an article in The Telegraph about our ongoing war with a clever, evolving parasite…

Malaria’s resistance to drugs is truly bad news
Using the latest drugs against malaria sparingly where resistance is present could make them useful for decades, says Andrew Read.

By Andrew Read
Published: 7:31AM BST 30 May 2009

So it looks like the malaria parasite wins again. Two research teams in Cambodia have discovered parasites resistant to the only fully effective malaria drug we have left. This is truly bad news. Resistance has already arisen to all other classes of front line drug, and many early generations of wonder drugs are now rendered useless. The new discovery is of resistance to the artemisinins, the latest drugs. These form the backbone of plans to globally eradicate malaria.

For most of us in the business, the discovery is depressing news, but no great surprise. It was a matter of when, not if. We can easily make resistant parasites in the laboratory, simply by throwing drugs at the parasites, and artemisinin is no exception. There is an ongoing arms race between the drug developers and the parasites. Just to stand still will cost $US2.5 billion over the next decade. Evolution is a very costly business.

The new discovery, if confirmed, signals the beginning of the end for artemisinin, but the end itself is a long way off. For one thing, the resistant parasites are still being killed by the drug – it is just takes longer. High-level resistance has yet to appear. For another, the resistance has a long way to go before it is common even in Cambodia, let alone the world. There is talk of trying to eradicate malaria in this region of South East Asia before the resistance is exported to Africa. I frankly doubt that is feasible, but I hope I am wrong.

But something else can be done. Resistant parasites spread because of drug use. If artemisinin is used sparingly where resistance is present, it could remain globally useful for decades. Easily enough time to get next-generation drugs deployed. Let the sequel begin.

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