E-drug: Lancet: Antimalarial combinations
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Antimalarial combinations
Peter Gottfried Kremsner, Sanjeev Krishna Lancet 2004; 364: 285-94
http://www.thelancet.com/journal/vol364/iss9430/full/llan.364.9430.review_and_opinion.30244.1
[Repair long URL]
Multidrug resistance has rendered monotherapy for malaria useless in
most parts of the world, and has also compromised the usefulness of
many of the available combination chemotherapies. New antimalarial
regimens are, therefore, urgently needed. We review the various
antimalarial combinations that can be used to treat otherwise drug
resistant disease, and discuss what defines an ideal antimalarial
combination regimen.
This long article discuss the rationale for combinations of
antimalarials, their roles and their comparative efficacy.
Combinations discussed in detail are
Artemisinin-containing regimens
Sulfadoxine-pyrimethamine
Sulfadoxine-pyrimethamine+chloroquine
Sulfadoxine-pyrimethamine+amodiaquine
Sulfadoxine-pyrimethamine+quinine
Sulfadoxine-pyrimethamine-mefloquine
Atovaquone-proguanil
Chlorproguanil-dapsone
Quinine+tetracycline
Quinine+clindamycin
Artesunate+amodiaquine
Artesunate+sulfadoxine-pyrimethamine
Artemether-lumefantrine
Artesunate+mefloquine
The authors conclude
The future
Multidrug resistance in parasites has forced the use of combination
antimalarial regimens. The need for effective treatments has thrown
together antimalarial combinations that have often worked better than
monotherapies, though sometimes only temporarily. However, we are
still far from discovery of an ideal regimen. The best options
available now include: mefloquine+ artesunate, which works well in
Thailand, although little is known about how this combination
translates to high transmission areas; and clindamycin+quinine, which
is effective in non-immune individuals, suggesting that
clindamycin+artesunate should also be studied.
Dihydroartemisinin-piperaquine and fosmidomycin-clindamycin are
promising treatment candidates. Until better regimens become
available there are enormous demands on policy makers to choose
between existing combinations, many of which have not been
sufficiently studied for informed judgments to be made.
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