SCIENCENVIRO (Opinion): Anti-Malarial Drug

Protecting an anti-malarial drug from developing resistance

• It is a drug that has its roots in ancient Chinese medicine. In the fight against malaria, a disease that over 200 million people are estimated to have caught in 2010, some 655,000 of whom died of it, protecting the effectiveness of artemisinin-based drugs has become vitally important.
• A number of Indian pharmaceutical companies have been among those manufacturing and marketing drugs that are likely to foster resistance to artemisinin in the malaria parasite
  
• Artemisin and its derivatives have saved countless lives after the single-celled parasite, Plasmodium falciparum , that causes the most dangerous forms of the disease became resistant to the drug chloroquine.
• However, strains that are resistant to even artemisinin have emerged in parts of South-East Asia and could potentially spread, as has happened with earlier antimalarial drugs.
• “A looming threat to malaria control is the emergence of parasites that are resistant to antimalarial medicines,” pointed out the World Health Organisation (WHO) in its ‘Global Plan for Artemisinin Resistance Containment' published earlier this year.
• Resistance had developed to every antimalarial medicine used so far. When that happened, the burden of malaria increased. Child mortality in Africa increased, for instance, as P. falciparum strains that were resistant to chloroquine spread in the 1970s and the 1980s.
• Although the problem of artemisinin resistance is currently confined to the Mekong river region, there is now “early evidence” of such resistance in Myanmar and Vietnam
• Giving artemisinin and its derivatives alone as 'monotherapies,' instead of as a cocktail with another drug, could create opportunities for resistant forms of the parasite to arise and spread.
• To prevent that from happening, the global health agency recommends that artemisinin be given in combination with another drug. Such artemisinin-based combination therapy (ACT) should, it says, be first-line treatment for uncomplicated malaria caused by P. falciparum . The two-drug combination reduced the chances of the parasite developing resistance.
• Most of the countries that still allow the marketing of monotherapies are located in the African Region, while most of the manufacturers are located in India.
• The WHO has called on all manufacturers to cease the marketing of monotherapies. Oral artemisinin monotherapy is banned in India and thus the manufacturing of such monotherapies for export should also be stopped.