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Steve M. Taylor, Jonathan J. Juliano, Artemisinin Combination Therapies and Malaria Parasite Drug Resistance: The Game Is Afoot, The Journal of Infectious Diseases, Volume 210, Issue 3, 1 August 2014, Pages 335–337, https://doi.org/10.1093/infdis/jiu142
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(See the major article by Conrad et al on pages 344–53.)
Artemisinin therapies for malaria are a revolutionary medical advance [1]. Derivatives of artemisinin are highly effective killers of malaria parasites and reduce Plasmodium falciparum densities in a log-linear fashion. They are therefore first-line therapy for uncomplicated and severe falciparum malaria across the globe [2]. For uncomplicated falciparum malaria, treatment typically entails a short course of an artemisinin derivative coformulated with a partner antimalarial as artemisinin combination therapy (ACT); in 2013, these ACTs were administered in >330 million courses globally [3].
ACT resistance would imperil malaria control. Consequently, sophisticated efforts are under way to quantify and track parasite susceptibility both to ACTs and to artemisinins themselves. In recent years, parasites in western Cambodia have cleared progressively more slowly from the blood after artemisinin therapy, a finding considered to be a potential early sign of artemisinin resistance and a harbinger of clinical failures [4]. To better detect these parasites, this phenotype has recently been associated with several polymorphisms in a novel parasite gene [5], and coordinated efforts are under way to track, contain, and eliminate these artemisinin-resistant parasites before their export from Southeast Asia. These efforts are critical, and it is imperative that efforts to sustain the longevity of ACTs do not overlook the importance to parasite killing of the artemisinin partner drugs.
