E-DRUG: WHO on artemisine combination therapy
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[a busy week for E-druggers... First a new EDL, then ART guidelines, then
the Global Fund, and now combination malaria treatment...
A pity that the WHO expert committee did not (yet) approve amodiaquine as
an oral treatment drug for malaria. The feared toxicity might be less than
for the 10 ARVs approved in the same meeting... WB]
Press Release WHO/31
25 April 2002
WHO URGES COUNTRIES TO ACT ON
NEW ANTI-RESISTANCE MALARIA MEDICINES
Geneva -Tackling rising levels of medicine resistance is one of the
key challenges to African States in their efforts to control malaria
and meet the declared target of saving the lives of half the 800,000
young children who die of the disease every year by 2010.
The cheapest and most readily available medicines are increasingly
ineffective. That's why the World Health Organization (WHO) in its
programme to Roll Back Malaria is urging countries to switch to a new
type of combination therapy when there is strong evidence that
existing conventional medicines are no longer working.
The Artemisinin-Based Combination Therapies (ACTs) are derived in part
from a Chinese herb and are the most exciting prospect in new malaria
treatments. They kill the malaria parasite very fast, allowing the
patient to recover rapidly, and with very few side effects.
Because ACTs combine two medicines which work in different ways, it is
unlikely that the malaria parasite - which has rapidly developed
resistance to other, single treatments - would evolve to resist these
medicine combinations.
WHO has just added one of the combination medicines
(artemether/lumefantrine) to its Essential Medicines List - a list
which prioritises essential medicines for countries.* This medicine,
known by the brand name Coartem, is the only medicine which combines
an artemisinin and non-artimisinin compound in a single tablet. WHO
also recommends other combinations of artemisinin compounds with
currently used medicines, such as amodiaquine or
sulfadoxine-pyrimethamine, for use where these medicines are still
effective.
The Board of the Global Fund to Fight AIDS, TB and Malaria, meeting in
New York, have decided to fund proposals to "Roll Back Malaria" in
Zanzibar and Zambia. These proposals include purchasing and phasing-in
the use of new ACTs.
"We hope that the Fund and other funding mechanisms will be used to
purchase ACTs where they are needed to treat malaria and improve the
control of the disease in communities at risk," Dr Gro Harlem
Brundtland, Director-General of WHO. "WHO has worked with a variety of
partners including the manufacturers to reduce the price of ACTs in
developing countries. It is important that countries which need ACTs
are able to access and use them in a sustainable manner."
For decades, the best known treatment for malaria was chloroquine, an
inexpensive medicine that has saved millions of lives. However, in
recent years, the malaria parasite has developed resistance to
chloroquine and so, in many countries, it is no longer an effective
treatment. Many countries in Eastern, Central and Southern Africa are
already experiencing high levels of resistance to chloroquine, and
resistance is also appearing more and more in West Africa.
As a result, many countries have moved to sulphadoxine-pyrimethamine,
known as SP or "Fansidar", as first line treatment. However,
resistance to SP is also spreading.
There is new evidence that the number of child deaths due to malaria
has begun to increase as a result of failing medicines and medicines
of poor quality. Recent evidence also indicates that, due to rising
levels of medicine resistance, almost half of the money spent on
anti-malarial medicines is being used to pay for inappropriate
treatments. This also highlights the need for more efforts on
preventing malaria, using proven cost-effective measures such as
insecticide treated bednets.
It takes time to change medicine policy and to implement the change.
New sources of materials and financing have to be found, medical
personnel trained, and distribution channels ensured. As more
countries start deploying these new combination medicines it is
expected that their production will be scaled up to meet the demands.
Additional safety information on these medicines is now being sought
in special groups at risk such as young infants and pregnant women.
Improved packaging of these medicines will help to ensure that
patients adhere to the full treatment course.
WHO recommends that countries begin the transition as soon as levels
of resistance exceed 15% and that the change will be implemented
before resistance reaches 25%.
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