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Artemisinin resistance: current status and scenarios for containment

Nature Reviews Microbiology volume 8, pages 272–280 (2010)Cite this article

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An Erratum to this article was published on 24 May 2010

Key Points

  • Malaria, caused by Plasmodium spp., remains a tremendous disease burden worldwide, causing nearly one million deaths and 250 million cases of disease.

  • Artemisinin and artemisinin derivatives are effective antimalarials, especially when coupled with a second, unrelated antimalarial.

  • Owing to the use of artemisinin as a monotherapy, strains of Plasmodium falciparum have emerged that have a decreased sensitivity to the drug.

  • Several strategies to prevent the spread of the less resistant parasites have been put in place, such as a multifaceted approach that includes early diagnosis and appropriate treatment, decreasing drug pressure, optimising vector control, targeting the mobile population, strengthening of management and surveillance systems, and operations research.

  • Other, broader strategies can target the emergence and spread of drug resistance. These include mass drug administration, using multiple first-line therapies simultaneously, surveillance, active case investigation and focal control

Abstract

Artemisinin combination therapies are the first-line treatments for uncomplicated Plasmodium falciparum malaria in most malaria-endemic countries. Recently, partial artemisinin-resistant P. falciparum malaria has emerged on the Cambodia–Thailand border. Exposure of the parasite population to artemisinin monotherapies in subtherapeutic doses for over 30 years, and the availability of substandard artemisinins, have probably been the main driving force in the selection of the resistant phenotype in the region. A multifaceted containment programme has recently been launched, including early diagnosis and appropriate treatment, decreasing drug pressure, optimising vector control, targeting the mobile population, strengthening management and surveillance systems, and operational research. Mathematical modelling can be a useful tool to evaluate possible strategies for containment.

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Figure 1: Chemical structure of artemisinins.
Figure 2: The life cycle of Plasmodium falciparum.
Figure 3: The study site in Pailin, western Cambodia.
Figure 4: Parasite clearance rates.

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Acknowledgements

We thank N. J. White for his critical review of the paper. This work was supported by the Wellcome Trust.

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Authors and Affiliations

  1. Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand

    Arjen M. Dondorp, Shunmay Yeung, Lisa White, Nicholas P.J. Day & Lorenz von Seidlein

  2. Centre for Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK

    Arjen M. Dondorp, Lisa White & Nicholas P.J. Day

  3. London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK

    Shunmay Yeung, Chea Nguon & Duong Socheat

  4. The National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia

    Duong Socheat

  5. Joint Malaria Project, Tanga, Tanzania

    Lorenz von Seidlein

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Correspondence to Arjen M. Dondorp.

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Glossary

Parenteral

Administered by injection.

Recrudescence

Reoccurence of a disease after treatment. This can be caused by parasites that were not completely eliminated during the treatment.

Hypnozoite

A dormant form of the liver stage parasites found in several Plasmodium spp., including the human parasites Plasmodium vivax and Plasmodium ovale.

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Dondorp, A., Yeung, S., White, L. et al. Artemisinin resistance: current status and scenarios for containment. Nat Rev Microbiol 8, 272–280 (2010). https://doi.org/10.1038/nrmicro2331

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