Monotherapy Artemisinin Issue Not Resolved

United Press International reports that Kunming Pharmaceutical Corp. maintains that its monotherapy artemisinin product is safe despite WHO trying to clamp down on sales and distribution of monotherapy malaria drugs in order to prevent resistance.  Although Ferreira et al. (2007) note that African surveys have observed that the overall susceptibility to artemisinin derivatives is relatively high they found potential opportunities for resistance to develop and therefore recommend, “Close monitoring of local parasite susceptibility and of putative genetic modulators of drug responses should carry on in view of protecting the long-term efficacy of ACT.”

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There is no point waiting until full blown resistance develops before taking action, hence WHO’s call for eliminating monotherapy artemisinin drugs before it is too late.  In stark terms WHO’s malaria chief, Arata Kochi, says, “If we lose artemisinin, we are dead, basically.”

In addition to the natural development of resistance over time one finds human induced problems. Atemnkeng et al., (2007) warn that, “Counterfeit or substandard artemisinin-derivative drugs are being sold in parts of Africa, presenting a potential route for resistance development in the future.”

Ultimately the will and ability to preserve our pharmaceutical arsenal against malaria rest with national governments who set malaria drug policies and guidelines and whose various food and drug regulatory agencies approve which malaria drugs are sold and dispensed.  Mugittu et al. (2006) commend preventive policies. Even though resistance to artemisinin has not yet been selected in Tanzania, they commend the Ministry of Health for making the decision to adopt artemether+lumefantrine as first-line malaria treatment. Governments in endemic countries like that of Tanzania need to step forward and protect their populations against drug-resistant malaria.

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