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Review
. 2010 Jun;10(6):405-16.
doi: 10.1016/S1473-3099(10)70079-7.

Artemisinin combination therapy for vivax malaria

Nicholas M Douglas  1 , Nicholas M Anstey, Brian J Angus, Francois Nosten, Ric N Price
Affiliations
Review

Artemisinin combination therapy for vivax malaria

Nicholas M Douglas et al. Lancet Infect Dis. 2010 Jun.

Abstract

Early parasitological diagnosis and treatment with artemisinin-based combination therapies (ACTs) are key components of worldwide malaria elimination programmes. In general, use of ACTs has been limited to patients with falciparum malaria whereas blood-stage infections with Plasmodium vivax are mostly still treated with chloroquine. We review the evidence for the relative benefits and disadvantages of the existing separate treatment approach versus a unified ACT-based strategy for treating Plasmodium falciparum and P vivax infections in regions where both species are endemic (co-endemic). The separate treatment scenario is justifiable if P vivax remains sensitive to chloroquine and diagnostic tests reliably distinguish P vivax from P falciparum. However, with the high number of misdiagnoses in routine practice and the rise and spread of chloroquine-resistant P vivax, there might be a compelling rationale for a unified ACT-based strategy for vivax and falciparum malaria in all co-endemic regions. Analyses of the cost-effectiveness of ACTs for both Plasmodium species are needed to assess the role of these drugs in the control and elimination of vivax malaria.

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Figures

Figures 1a and 1b
Figures 1a and 1b
Reports of chloroquine-resistant Plasmodium vivax by 1999 (a) and 2009 (b). Red stars = >10% recurrence (and greater than 5 absolute failures) by day 28 with or without chloroquine levels; orange diamonds = <10% recurrence (or less than 5 absolute failures) by day 28, with chloroquine levels; yellow circles = <10% recurrence (or less than 5 absolute failures) by day 28, without chloroquine levels.
Figures 1a and 1b
Figures 1a and 1b
Reports of chloroquine-resistant Plasmodium vivax by 1999 (a) and 2009 (b). Red stars = >10% recurrence (and greater than 5 absolute failures) by day 28 with or without chloroquine levels; orange diamonds = <10% recurrence (or less than 5 absolute failures) by day 28, with chloroquine levels; yellow circles = <10% recurrence (or less than 5 absolute failures) by day 28, without chloroquine levels.
See this image and copyright information in PMC

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