Improper Use, Regulation of ACTs Leading to Drug Resistance, Study Says

The misuse and inadequate regulation of artemisinin-based combination therapies to treat malaria in some countries is leading to increasing resistance to the drugs, according to a study published in the Dec. 3 issue of the Lancet, the Guardian reports. ACTs recently have become first-line malaria treatments in many countries after chloroquine and other drugs became ineffective against the Plasmodium falciparum parasite because of widespread resistance. However, the study's findings indicate that P. falciparum might already be developing resistance to ACTs in some countries (Boseley, Guardian, 12/2). Ronan Jambou of the Institut Pasteur de Dakar in Senegal and colleagues collected blood samples from 530 malaria patients in Cambodia, French Guiana and Senegal. The researchers then exposed the parasites in the blood samples to a range of ACTs (AFP/News24.com, 12/2). They found that parasites in the samples collected from French Guiana and Senegal had developed resistance to the drugs, but the parasites in the samples from Cambodia had not. According to the researchers, artemisinins are not taken in combination with other drugs or are not used properly in French Guiana and Senegal, while the drugs are regulated in Cambodia. Although the study does not indicate that ACTs are no longer effective in the two African countries, the researchers said the findings are "the probable first step of an alarming cascade." They added that "increased vigilance and a coordinated rapid deployment of drug combinations" is needed to prevent further resistance. In an accompanying opinion piece, Patrick Duffy and Carol Hopkins Sibley of the Seattle Biomedical Research Institute write that "the expectation that all combinations with artemisinins will have a long therapeutic life may be overly optimistic" (Guardian, 12/2). Duffy said that it is important to conduct thorough surveillance in countries where ACTs are used to ensure that they are used and distributed correctly (Berman, VOA News, 12/1).