Antimalarial drugs are meant to cure or prevent malaria. They have been always under the scanner because the malaria parasite often develops resistance to them. This is why the current idea of antimalarial medication is one of combination. This has many advantages including convenience and lesser side-effects, lesser risk of treatment failure, and most importantly, lesser risk of drug-resistance in the malaria parasite.
Some antimalarial drugs are Quinine, Chloroquine, Pyrimethamine, Proguanil, Amodiaquine, Sulfonamides, Atovaquone, Mefloquine, Artemisinin, Halofantrine, Primaquine, Doxycycline and Clindamycin. Chlorquine was the most widely used antimalarial drug but drug-resistance developed by malaria parasites of late has rapidly reduced its efficiency. These days, it is used in combination with other antimalarial drugs to improve its effectiveness.
The biological influences for drug resistance depend on the ability of parasites to survive in the presence of antimalarial drugs. Under normal circumstances, the parasites that remain in the patient after treatment are eliminated by his immune system. Any factors that stop this process of parasites’ elimination contribute to development of drug-resistance in them.
Combination Therapy for Effectiveness of Antimalarial Drugs
A drug based on combination therapy aims at different biochemical targets in a parasite with the end of the essential anti-malarial care as well as preventing the parasite from developing resistance. Despite there being enough evidence to support the use of drugs in combination, several factors prevent it from being widely used. These are –
There are two types of combination therapies –
1. Fixed-dose – Two or more drugs are combined into one tablet. This is also called non-artemisinn based combination therapies.
2. Artemisinn-based – Two different antimalarials are used. This type of malaria treatment has been largely successful in its objective of avoiding drug resistance and there have been very few reports of side-effects. More data need be accumulated to get a better picture of this.
WHO guidelines of 2010 stated that artemisinn-based formulations are the best choice for treatment of any uncomplicated malaria infection caused by P. falciparum. Effectiveness of antimalarial drugs depends on climatic and individual factors too.
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