Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach

Article English OPEN
Antao, Tiago ; Hastings, Ian (2012)
  • Publisher: BioMed Central
  • Journal: Malaria Journal, volume 11, pages 422-422 (issn: 1475-2875, eissn: 1475-2875)
  • Related identifiers: pmc: PMC3546853, doi: 10.1186/1475-2875-11-422
  • Subject: qx_135 | Treatment | Drugs | Adherence | qv_256 | Infectious Diseases | wa_395 | wc_765 | Malaria | Resistance | Research | wc_750 | RC955-962 | RC109-216 | Plasmodium falciparum | Infectious and parasitic diseases | Arctic medicine. Tropical medicine | Policy | Parasitology

<p>Abstract</p> <p>Background</p> <p>Anti-malarial drugs are constantly exposed to the threat of evolving drug resistance so good stewardship of existing therapy is an essential component of public health policy. However, the widespread availability of numerous different drugs through informal providers could undermine official drug deployment policies. A policy of multiple first-line therapy (MFT) is compared with the conventional policy of sequential drug deployment, i.e., where one drug is used until resistance evolves and then replaced by the next drug in the sequence.</p> <p>Methods</p> <p>Population genetic models of drug resistance are used to make the comparison; this methodology explicitly tracks the genetics of drug resistance (including, importantly, recombination in the sexual stage, intrahost dynamics, and direction of linkage disequilibrium).</p> <p>Results</p> <p>A policy of MFT outlasts sequential application providing drug usages are low to moderate, and appears not to drive widespread multi-drug resistance. Inadequate dosing is an even more potent driver of drug resistance than the MFT/sequential policy decision.</p> <p>Conclusions</p> <p>The provision of MFT as a deliberate policy can be encouraged provided overall treatment rates are low or moderate (less than around half of malaria infections are treated) and the <it>ad hoc</it> provision of MFT through the private sector may be tolerated. This must be fully supported by education to ensure people take adequate doses of each of the drugs.</p>
  • References (46)
    46 references, page 1 of 5

    1. Okiro EA, Bitira D, Mbabazi G, Mpimbaza A, Alegana VA, Talisuna AO, Snow RW: Increasing malaria hospital admissions in Uganda between 1999 and 2009. BMC Med 2011, 9:37.

    2. Russel S: The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. Am J Trop Med Hyg 2004, 71:147-155.

    3. Attaran A, Barnes KI, Curtis C, D'Alessandro U, Fanello CI, Galinski MR, Kokwaro G, Looareesuwan S, Makanga M, Mutabingwa TK, Talisuna A, Trape JF, Watkins WM: WHO, the Global Fund, and medical malpractice in malaria treatment. Lancet 2004, 363:237-240.

    4. Bosman A, Mendis KN: A major transition in malaria treatment: the adoption and deployment of artemisinin-based combination therapies. Am J Trop Med Hyg 2007, 77:193-197.

    5. Hastings IM: How artemisinin-containing combination therapies slow the spread of antimalarial drug resistance. Trends Parasitol 2011, 27:67-72.

    6. Laufer M, Thesing P, Eddington N, Masonga R, Dzinjalamala F, Takala S, Taylor T, Plowe C: Return of chloroquine antimalarial efficacy in Malawi. N Engl J Med 2006, 355:1959-1966.

    7. World Health Organization: Guidelines for the treatment of malaria. 2nd edition. Geneva, Switzerland: World Health Organization; 2010.

    8. Bate R, Coticelli P, Tren R, Attaran A: Antimalarial drug quality in the most severely malarious parts of Africa-a six country study. PLoS One 2008, 3:e2132.

    9. Boni MF, Smith DL, Laxminarayan R: Benefits of using multiple first-line therapies against malaria. Proc Natl Acad Sci USA 2008, 105:14216-14221.

    10. Razakandrainibe FG, Durand P, Koella JC, De Meeus T, Rousset F, Ayala FJ, Renaud F: "Clonal" population structure of the malaria agent Plasmodium falciparum in high-infection regions. Proc Natl Acad Sci USA 2005, 102:17388-17393.

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