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Combination Therapy for Malaria

The Way Forward?

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Abstract

Unless new strategies are deployed to combat malaria, the already enormous health and economic burden related to the disease in tropical countries is bound to worsen. The main obstacle to malaria control is the emergence of drug resistant strains of Plasmodium falciparum. As for HIV/AIDS and tuberculosis, the use of combinations of antimalarial drugs reduces the risk of selecting for resistant mutants of the plasmodial parasites. In large field trials, the combination of an artemisinin derivative and a partner drug with an unrelated mode of action (in this case mefloquine), has shown a remarkable double effect: preventing the emergence and spread of drug resistance, and interrupting the transmission of P. falciparum. This has opened the way for a new approach to the deployment of antimalarial drugs. Coupled with early detection and confirmed diagnosis, this strategy represents the only way forward in the chemotherapy of malaria. Massive economic assistance will be needed to detect and treat adequately the estimated 500 million cases of malaria per year, but without radical action there is no prospect of ‘Rolling Back’ malaria.

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Acknowledgements

There was no specific source of funding for the preparation of this manuscript and no conflict of interest. The views expressed here are only those of the authors.

We are grateful to Drs E. Ashley, P. Guerin, Prof. N.J. White, Amir Attaran and R. Price for their comments on the manuscript. F. Nosten is a Wellcome Trust Senior Clinical Fellow.

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Authors and Affiliations

  1. Shoklo Malaria Research Unit, PO Box 46, Mae Sot, 63110, Thailand

    François Nosten

  2. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

    François Nosten

  3. Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, John Radcliffe Hospital, Oxford, UK

    François Nosten

  4. Laboratory of Parasitology, Hôpital Charles Nicolle, Rouen, France

    Philippe Brasseur

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Nosten, F., Brasseur, P. Combination Therapy for Malaria. Drugs 62, 1315–1329 (2002). https://doi.org/10.2165/00003495-200262090-00003

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