Antimalarial Drug Resistance

Subject – Science and Tech

Context – On September 23, the New England Journal of Medicine published an article `Evidence of Artemisinin-Resistant Malaria in Africa’

Concept –

In most malaria-endemic countries including India, Artemisinin-based antimalarial drugs are the first-line choice for malaria treatment especially against Plasmodium falciparumparasite which is responsible for almost all malaria-related deaths in the world.
In recent years there is increasing evidence for the failure of artemisinin-based combination therapy for falciparum malaria either alone or with partner drugs.
In India, after the failure of chloroquine to treat falciparummalaria successfully, artemisinin-based combination therapy was initially introduced in 117 districts that reported more than 90% falciparum burden in 2008.
In 2010, artesunate plus sulfadoxine-pyrimethamine (AS+SP) was introduced universally, but in 2013, in view of resistance to the partner drug SP in the seven North Eastern States, the combination partner was replaced by artemether-lumefantrine (AL) for these states.
Currently, several combinations of artemisinin derivatives are registered in India.

Artemisinin-based combination therapy failure in India

In 2019, a report from Eastern India indicated the presence of two mutations in P. falciparum cases treated with artemisinin that linked to its presence of resistance.
Again in 2021, artemisinin-based combination therapy failure was reported from Central India where the partner drug SP showed triple mutations with artemisinin wild type.
This means the failure of artemisinin-based combination therapy may not be solely linked to artemisinin. Here it is needed to change the partner drug as has been done in NE states in 2013.
In the past, chloroquine was very effective for all types of malaria treatment in India. But it is no longer used for the treatment of falciparum malaria.
Though there have been some reports of chloroquine resistance in P. vivax malaria, this drug is still the effective choice to treat this species.
Reports of the presence of chloroquine resistance mutations in some vivax-dominated areas are a cause of concern and continued monitoring is needed.

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