COMBINATION THERAPY AND ITS IMPLICATION ON CLINICAL EFFICACY OF ARTEMISININS- REVIEW

Artemisinin and its derivatives have successfully been used in treatment of falciparum malaria infections in various parts of the world. More importantly, they have proved effective against strains resistant to conventional antimalarials such as chloroquine and mefloquine in those parts of the world where malaria is endemic. Only one clinically relevant artemisinin-resistant human malaria has been reported recently in South East Asia, although there are reports published on development of the rodent malaria parasite strains resistant to the drug earlier. This article reviews the implications of combination therapy on the pharmacokinetics and hence clinical efficacy of Artemisinins using relevant and published papers. It gives detailed account on the general chemistry and mechanism of action of the parent compound Artemisinin before considering its pharmacokinetics. Artemisinin-based combination treatments (ACTs) are now generally accepted as the best treatment options for uncomplicated falciparum malaria. They are rapidly and reliably effective. The article would focus on combination therapy & its implication on the pharmacokinetics & clinical efficacy of artemisinin & its derivatives and also presents the scientific rationale for the need of combining Artemisinins to enhance their clinical efficacy and also minimize the likelihood of the emergence of resistant strains of the malarial parasites