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Emerging trends malaria
1. Emerging trends in the therapy of Malaria Better clarity, Better outcomes Dr. B. K. Iyer
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6. Antimalarials on the Horizon In response to the antimalarial drug resistance situation, WHO recommends that treatment policies for falciparum malaria in all countries experiencing resistance to monotherapies, should be combination therapies, preferably those containing an artemisinin derivative (ACT – artemisinin-based combination therapy ). 2003 1990s 1980s 1970s 1960s 1950s 1940s 1930s <1930 Chlorproguanil-dapsone Atovaquone-proguanil Halofantrine Artemisinin Sulfa-Pyrimethamine Pyrimethamine Proguanil Mepacrine Pamaquine Artemether-lumefantrine Pyronaridine Primaquine Amodiaquine Chloroquine Quinine Mefloquine Artemether Artesunate Not adopted by malaria programs Being abandoned due to resistance Fixed Dose Combinations
7. Therapeutic Efficacy of SP in Africa: Evidence to Guide Action West Central East THRESHOLD FOR CHANGE 15
9. Implications in Africa Policy change in Africa: choice of 1st-line treatment CQ SP/AQ CQ AQ+SP CQ/SP ACT INTERIM <1993 1998 1999 2000 2001 2002 2003 CQ CQ+SP Malawi S.Africa Kenya Botswana Tanzania Ethiopia Zimbabwe Uganda S.Africa Rwanda DRC Burundi Zambia Eritrea Zanzibar Cameroon (AQ) Coartem Burundi Gabon Comores Mozambique Senegal Côte d’Ivoire
10. Combination Therapies: Definition What Parallel use of 2 or more antimalarials as free / fixed combinations to delay antimalarial drug resistance in Falciparum malaria Hypertension Cancer Diabetes Tuberculosis AIDS Combination therapy
36. Amqunate studies How Lancet, volume 359, number 9315, page 1365-1372, 20 April 2002.
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40. One Vital Question Treatment of Uncomplicated Falciparum Malaria in Southern Vietnam: Can chloroquine or sulfadoxine-pyrimethamine be reintroduced in combination with artesunate? Clinical Infectious Diseases 2003;37:1461-1466 How Can Conventional antimalarial Resistance Be Reversed in Combination With artesunate? The successful reintroduction of conventional therapies in combination with artesunate depends on epidemiological and / or parasitological factors and is not predictable since it varies from place to place.
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