Artemisinin-based combination therapies for uncomplicated malaria

(.) There has been a relentless increase in resistance of malaria parasites to conventional antimalarial drugs, including chloroquine, sulfadoxine-pyrimethamine and mefloquine. (.) In response to this situation, short-course artemisinin-based combination therapies (ACTs) have been developed. (.) The World Health Organization has endorsed ACT as first-line treatment where the potentially life-threatening parasite Plasmodium falciparum is the predominant infecting species. (.) ACTs combine the rapid schizontocidal activity of an artemisinin derivative (artesunate, artemether or dihydroartemisinin) with a longer-half-life partner drug. (.) Although the use of chloroquine and sulfadoxine-pyrimethamine as partners in ACT improves their efficacy, this may only have value as a short-term measure in patients with a degree of immunity to malaria. (.) Alternative currently available partner drugs include mefloquine, lumefantrine and piperaquine. (.) Artesunate-mefloquine is highly effective but is expensive and side effects (mainly neurotoxicity) can be problematic. (.) Artemether-lumefantrine, the only ACT available in Australia, appears less effective than artesunate-mefloquine and needs to be administered with food to ensure adequate bioavailability. (.) Dihydroartemisinin-piperaquine is highly effective, well tolerated and relatively inexpensive. (.) The goal of potent, safe, easy-to-administer and inexpensive ACTs may see trioxolanes in place of artemisinin derivatives, as well as novel partner drugs such as pyronaridine or naphthoquine, in the future.