Journal
INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE
Volume 2, Issue -, Pages 249-255Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ijpddr.2012.01.001
Keywords
Plasmodium falciparum; Artemisinin; Treatment failure; Dormancy; Artemisinin resistance
Categories
Funding
- US NIAID [R01 AI058973]
- NHMRC CDA
- Research and Policy for Infectious Disease Dynamics (RAPIDD) program of the Science and Technology Directorate
- Department of Homeland Security
- Fogarty International Centre, National Institutes of Health
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Artemisinin (ART) based combination therapy (ACT) is used as the first line treatment of uncomplicated falciparum malaria in over 100 countries and is the cornerstone of malaria control and elimination programs in these areas. However, despite the high potency and rapid parasite killing action of ART derivatives there is a high rate of recrudescence associated with ART monotherapy and recrudescence is not uncommon even when ACT is used. Compounding this problem are reports that some parasites in Cambodia, a known foci of drug resistance, have decreased in vivo sensitivity to ART. This raises serious concerns for the development of ART resistance in the field even though no major phenotypic and genotypic changes have yet been identified in these parasites. In this article we review available data on the characteristics of ART, its effects on Plasmodium falciparum parasites and present a hypothesis to explain the high rate of recrudescence associated with this potent class of drugs and the current enigma surrounding ART resistance. (C) 2012 Australian Society for Parasitology Published by Elsevier Ltd. All rights reserved.
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