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Thailand's struggle with multidrug-resistant falciparum malaria

Jun. 22, 2017

In 1991, a clinical trial in Thailand was published proving that dosages of oral artesunate at 1200, 600 or 650 mg combined with 480 mg of intramuscular artemether to be an effective treatment for multidrug-resistant falciparum malaria.

In the trial, dosages were administered over five days, resulting in a 90 -100% cure rate. Where medications were taken for less than five days, there was a high rate of recrudescence.

Some cases revealed the medications to cause mild and transient side effects, including pain at the injection site and occasional abnormal electrocardiograms.

The introduction of ACT

In 1995, a new solution was introduced to the Thailand -Cambodia and Thailand -Myanmar borders. A combination of artemisinin-based combination therapy (ACT) and artesunate-mefloquine was introduced resulting in a temporary stabilization of the multidrug resistance problem.

Recent years have seen a growing trend of artemisinin resistance in P. falciparum multidrug-resistant malaria and chloroquine resistance in P. vivax multidrug-resistant malaria.

These challenges have been detected primarily along the Thailand -Cambodia and Thailand-Myanmar borders, as well as the Greater Mekong Subregion.

The World Health Organization's response

In 2013, the World Health Organization (WHO) began implementation of an emergency response to artemisinin resistance in the Greater Mekong Subregion.

The goal of the response was to contain the spread of drug-resistant parasites and provide life-saving tools for those who were at risk of malaria.

Despite this response from the WHO, other cases of resistance to ACT emerged and as a result, the WHO'S Malaria Policy Advisory Committee set a hard goal in 2014 --to eliminate P. falciparum malaria in the Greater Mekong Subregion by 2030.

With unanimous endorsement by all the countries in the subregion, WHO launched the Strategy for Malaria Elimination in the Greater Mekong Subregion (2015 -2030) at the World Health Assembly in 2015.

The state of multidrug-resistant falciparum malaria in Thailand today

Despite the continued use of ACT and the WHO's elimination efforts, multidrug-resistant P. falciparum malaria continues to plague Thailand, causing high rates of treatment failure and threatening global malaria control.

Top scientists are concerned that falciparum malaria may become untreatable, making it critically urgent to conduct effective clinical trials in Thailand.

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