Anti-malaria drug treatment in Vietnam

Abstract

Resistance to antimalarial drugs is increasing nearly everywhere in the tropical world, confounding global attempts to "Roll Back Malaria". Antimalarial treatment with artemisinin, artesunate, or artemether has proved rapidly effective in the treatment of non complicated and complicated malaria and remarkably nontoxic. However there is a number of important questions that still need urgent attention: Should artemisinin be deployed alone or in combination with other antimalarial drugs such mefloquine or other compound (s); which is the best regimen (s); can artemisinin and its derivatives (artesunate or artemether) reduce the mortality in severe malaria and which is the best drug(s); are there important neurotoxic side effects in patients treated with this group of antimalarial drugs. In order to answer those questions a series of studies were conducted in Vietnam and these form the basis of this thesis. The conclusion is 1/ Dihydroartemisinin-piperaquine is an inexpensive, safe, highly efficacious fixeddose antimalarial combination treatment that could make an important contribution to the control of multidrug-resistant fa1ciparum malaria for Vietnan1 and other countries. 2/ Artemether is a satisfactory alternative to quinine for the treatment of severe malaria in adults. The rectal administration of artemisinin would obviollsly constitute a useful therapeutic advance, in comparing with parenteral drugs such as artemether and artesunate, particularly in areas where parenteral administration is difficult. 3/ The artemisinin derivatives have an acceptable safety profile. 4/ Viet Nam has shown that it is possible to "Roll Back Malaria" assuming one has access to good drugs and a willingness to implement change. Those studies have helped to confirm that the qinghaosu (artemisinin) group of drugs is the most important new class of antimalarials developed in the last fifty years