Successful malaria control depends greatly on treatment with efficacious anti-malarial drugs. Malaria endemic countries have a National Malaria Treatment Policy that specifies drugs for treatment of both uncomplicated and severe malaria, malaria in pregnancy and what to do if first line treatment fails.
As the malaria parasite’s resistance develops to existing drugs, new ones need to be introduced. For plasmodium falciparum use of two or more drugs with different modes of action in combination is now recommended to provide adequate cure rate and delay the development of resistance.
Currently artemisinin-based combination therapy (ACT) is recommended for the treatment of P. falciparum malaria. Fast acting artemisinin-based compounds are combined with a drug from a different class. Companion drugs include lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, piperaquine and chlorproguanil/dapsone. Artemisinin derivatives include dihydroartemisinin, artesunate and artemether. A co-formulated drug is one in which two different drugs are combined in one tablet; this is important to ensure both drugs are used.
The benefits of ACTs are their high efficacy, fast action and the reduced likelihood of resistance developing. In order to make best use of them, particularly since no alternative is likely for several years, it is critical to address issues of delivery, access and cost.
Chloroquine is still the first line treatment for P.vivax and P. ovale, while primaquine can be used to treat liver stage parasites of P.vivax, in areas of low malaria transmission if adherence is guaranteed.
To find out more about ACTs and other malaria treatments, please visit WHO’s page on this issue.