Steps Must Be Taken To Avoid Resistance To Malaria Drug (6)
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Many thanks to Peter Burgess (afro-nets Digest, Vol 3, Issue
109, message 9) for pointing out the importance of disease pre-
vention in containing antimicrobial resistance. I was however
somewhat concerned that some may get the impression that cutting
justified use is an acceptable strategy for resistance control.
The purpose of combating resistance is to extend the life span
of a drug for its intended use. Withholding the drug from pa-
tients who need it is unethical and has never been an advocated
strategy. It also defeats the purpose of combating resistance in
the first place and untreated infected persons only serve as ve-
hicles to spread the disease, thereby ultimately increasing the
need for antimicrobials. Thus appropriate therapy for infection,
in addition to necessarily curing the patient, is a key strategy
for resistance control.
Readers are advised to see the WHO global strategy for resis-
tance containment, which outlines rational interventions, in-
cluding disease prevention. The strategy applies to all antim-
icrobials, including antimalarials. Peter Burgess' letter does
an excellent job of outlining key preventive strategies for ma-
laria. The prevention of infection is perhaps the most cost ef-
fective means to control resistance since it precludes the need
for antimicrobials. In addition, ensuring appropriate diagnosis
for malaria and making adequate supplies of antimalarials avail-
able will reduce inappropriate use as well as increase compli-
ance. Both these strategies could combat resistance whilst en-
suring patient welfare and reducing disease spread. In the long
term, the development and distribution of a greater variety of
effective antimalarials, and a preventive vaccine, would also
advance malaria control whilst reducing the effect of resis-
tance.
Useful links:
- The WHO stragegy for antimicrobial resistance containment:
http://www.who.int/drugresistance/en/
-Special issue of the Amercian Journal of Tropical Medicine and
Hygiene devoted to Malaria and Antimalarial resistance (Open Ac-
cess):
http://www.ajtmh.org/content/vol71/2_suppl/
- Recent Lancet Infectious Disease reviews on resistance (open
access after free registration at The Lancet)
http://www.thelancet.com/journals/laninf/article/PIIS1473309905702176/
http://www.thelancet.com/journals/laninf/article/PIIS1473309905701894/
- The Alliance for Prudent use of Antimicrobials
http://www.apua.org
Iruka N. Okeke
Assistant Professor
Department of Biology, Haverford College
370 Lancaster Avenue
Haverford, PA 19041, USA
mailto:i_okeke@hotmail.com