Advances and roadblocks in the treatment of malaria

The deployment of artesunate for severe malaria and the artemisinin combination therapies (ACTs) for uncomplicated malaria has been a major advance in antimalarial therapeutics. These drugs have reduced treated mortality, accelerated recovery and reduced treatment failure rates and transmission from the treated infection. Artemisinin derivatives remain highly effective against falciparum malaria in most malaria endemic areas, but significant resistance has emerged in the Greater Mekong subregion of Southeast Asia. Resistance to artemisinins was followed by resistance to the ACT partner drugs, and fit multidrug resistant parasite lineages have now spread widely across the region. ACTs remain highly effective againstP. vivaxand the other malaria species. Recent studies have shown that radical curative regimens of primaquine (to prevent relapse) can be shortened to 7 days, and that the newly introduced single dose tafenoquine is an alternative, although the currently recommended dose is insufficient in Southeast Asia and Oceania. Targeted malaria elimination using focal mass treatments with dihydroartemisinin-piperaquine have proved safe and effective malaria elimination accelerators, but progress overall towards malaria elimination is slow. Indeed since 2015 overall malaria case numbers globally have risen. As new drugs will not become widely available in the near future, active measures to preserve the current antimalarials should be given the highest priority.

Automated summary

The use of artesunate and artemisinin combination therapies (ACTs) in the treatment of severe and uncomplicated malaria respectively has been a significant advancement in antimalarial therapeutics. However, resistance to these treatments has emerged in Southeast Asia. Other treatments such as primaquine and tafenoquine have shown promise in preventing relapse, and targeted malaria elimination has been effective in certain areas. However, global progress towards malaria elimination has been slow, and it is crucial to prioritize the preservation of current antimalarials as new drugs are not expected to become widely available in the near future.