Why is it important to combine malaria drugs?

Online Q&A
23 January 2006

Q: Why is it important to combine malaria drugs?

A: In most parts of the world, falciparum malaria has become resistant to conventional treatment, such as chloroquine, sulfadoxine-pyrimethamine, and other antimalarial medicines used on their own. This is why WHO recommends that countries use a combination of drugs to fight malaria.

Our best weapon against these resistant malaria parasites is a combination of drugs that includes a compound derived from artemisinin — a substance extracted from the plant Artemisia annua — along with another antimalarial drug.

This combination of artemisinin derivatives with another effective antimalarial medicine is called artemisinin-based combination therapy (ACT) and is currently the most effective medicine available to treat malaria. When used correctly in combination with other anti-malarial drugs in ACTs, artemisinin is nearly 95% effective in curing malaria and the parasite is highly unlikely to become drug resistant.

Over the past decade, ACTs have been deployed on an increasingly large scale. ACTs produce a very rapid therapeutic response and are well tolerated by patients. ACTs also have the potential to reduce transmission of malaria.

56 countries, 34 of them in Africa, have officially adopted ACTs as their first line of treatment, although many are not yet implementing that policy. Thirty-two countries have adopted ACTs since January 2004 alone.

Malaria infects between 350 and 500 million people each year – and kills one million, most of them in Africa. Fighting malaria is a major public health imperative.

WHO has requested that all pharmaceutical companies immediately stop marketing and selling artemisinin malaria medicines as a stand alone treatment for uncomplicated malaria, because of risk that malaria parasites will develop resistance to the drug. WHO recommends instead that companies market artemisinin combination therapies (ACTs) only.

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