Artemisinin combination therapy for vivax malaria

Lancet Infect Dis. 2010 Jun;10(6):405-16. doi: 10.1016/S1473-3099(10)70079-7.

Abstract

Early parasitological diagnosis and treatment with artemisinin-based combination therapies (ACTs) are key components of worldwide malaria elimination programmes. In general, use of ACTs has been limited to patients with falciparum malaria whereas blood-stage infections with Plasmodium vivax are mostly still treated with chloroquine. We review the evidence for the relative benefits and disadvantages of the existing separate treatment approach versus a unified ACT-based strategy for treating Plasmodium falciparum and P vivax infections in regions where both species are endemic (co-endemic). The separate treatment scenario is justifiable if P vivax remains sensitive to chloroquine and diagnostic tests reliably distinguish P vivax from P falciparum. However, with the high number of misdiagnoses in routine practice and the rise and spread of chloroquine-resistant P vivax, there might be a compelling rationale for a unified ACT-based strategy for vivax and falciparum malaria in all co-endemic regions. Analyses of the cost-effectiveness of ACTs for both Plasmodium species are needed to assess the role of these drugs in the control and elimination of vivax malaria.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antimalarials / therapeutic use*
  • Artemisinins / therapeutic use*
  • Chloroquine / therapeutic use
  • Drug Resistance
  • Drug Therapy, Combination / methods
  • Humans
  • Malaria, Falciparum / drug therapy
  • Malaria, Vivax / drug therapy*
  • Plasmodium falciparum / drug effects
  • Plasmodium vivax / drug effects

Substances

  • Antimalarials
  • Artemisinins
  • Chloroquine
  • artemisinine