Sunday, 10 April 2011

MA:ARIA: Resistance - a barrier to malaria elimination

Bill Brieger : 07 Apr 2011

whd2011_230x60_en.gifThe World Health Organization reminds us today that, “Antimicrobial resistance is not a new problem but one that is becoming more dangerous; urgent and consolidated efforts are needed to avoid regressing to the pre-antibiotic era.” It is not just antibiotics that are in trouble, but other microbial agents including malaria drugs.
In the malaria community we are also worried about insecticide resistance. Growing resistance to DDT was one of the reasons that earlier efforts to eradicate the disease were not globally successful.
WHO explains clearly that human behavior (patients, providers, health service managers and drug manufacturers) plays a big role in developing antimicrobial resistance:
Antimicrobial resistance is facilitated by the inappropriate use of medicines, for example, when taking substandard doses or not finishing a prescribed course of treatment. Low-quality medicines, wrong prescriptions and poor infection control also encourage the development and spread of drug resistance. Lack of government commitment to address these issues, poor surveillance and a diminishing arsenal of tools to diagnose, treat and prevent also hinder the control of drug resistance.
Scientific American this month has two timely articles on antibiotic resistance that also highlight how human behavior exacerbates the problem. Agricultural use of antibiotics is one major problem. Another revolves around infection prevention procedures (or the lack thereof) in hospitals.
The use of combination drug treatments was expected to slow or prevent the emergence of resistance to another class of anti-malaria drugs, but prior and continued use of monotherapy artesunate drugs in Southeast Asia has raised the specter of resistance developing there and spreading throughout the world following the patterns of chloroquine and sulphadoxine-pyrimethamine. The following steps are designed to help:
Treatment only with combination therapies where there is no demonstrable resistance for either component of the combination
Treatment based only on positive results of parasitological tests thus avoiding indiscriminant use of malaria drugs
Regular/frequent drug efficacy testing using WHO protocols
Donors and National Malaria Control Programs must recognize and fund surveillance activities as one of the central interventions in efforts to eliminate malaria. As this year’s World Health Day theme clearly states: no action today, no cure tomorrow.

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