Artemisinin Combination Therapy (ACT) for Malaria Treatment

Artemisinin-based combination therapy is an effective tool in the fight against malaria. Artemisinin is also often taken by individuals travelling to malaria-affected locations as a preventative measure against the disease.

Nearly half of the world’s population – about 3.2 billion people – is at risk of malaria, according to the World Health Organization (WHO). There were approximately 198 million cases of malaria in 2013; the disease claimed an estimated 584,000 lives that year.

Individuals living in the poorest countries of the world face the greatest risk for exposure to malaria. Ninety percent of all malaria deaths occurred in the WHO African Region in 2013, striking mostly children younger than 5 years of age.

Fortunately, increased prevention, control measures and advanced medical treatment have reduced malaria mortality rates by 47 percent worldwide since 2000 and by 54 percent in the WHO African Region. Artemisinin combination therapy is responsible for much of this progress.

Artemisinin

Immunomodulator

Immunity

Anti- Viral

Chinese Medicine

How It Works:

• Anti-viral & immune supporting properties
• Promotes general health & anti-aging
• Used in Chinese medicine to boost Qi

Dosage:

Between 100 - 1000 mg per day

Safety:

Rated Possibly Safe

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Malaria Treatments

Five species of the malaria parasite cause clinical illness. One such species, P. vivax, is a common cause of malaria in Asia, South America and Oceania.

Like other species of malaria, P. vivax parasites travel to the liver and invade liver cells before moving into the bloodstream. Unlike other malaria species, P.vivax has a liver stage that does not respond to common anti-malarial drugs.

This species can become active in the liver and even cause a relapsed of illness weeks or years after the initial illness.

According to information presented in the Cochrane Database of Systematic Reviews, the standard treatment for P. vivax has been primaquine and chloroquine. These drugs interfere with the development and growth of the malaria parasite in the bloodstream.

The P. vivax parasite is now highly resistant to chloroquine, rendering this approach ineffective. Alternative therapies are needed as resistance grows and chloroquine effectiveness declines.

Current ACT combinations do not contain drugs effective against the liver stage of P. vivax so primaquine would still be necessary to achieve complete cure.

Artemisinin-based Combination Therapy

Isolated from the sweet wormwood plant, Artemisia annua, artemisinin and its derivatives reduce the number of plasmodium parasites in the bloodstream during the first three days of treatment.

In ACT, artemisinin works with a companion drug as an effective treatment for malaria. The partner drug eliminates any remaining parasites. The Malaria Consortium lists the following companion drugs:

• Lumefantrine
• Mefloquine
• Amodiaquine
• Sulfadoxine/pyrimethamine
• Piperaquine
• Chlorproguanil/dapsone

Parasites can develop resistance to artemisinin and its derivatives, which include dihydroartemisinin, artesunate and artemether. This means the artemisinin compound may not be able to clear all the parasites within three days.

Patients engaged in a longer ACT treatment regimen may still be cured, however, as long as they receive artemisinin combination therapy containing a partner drug effective for that geographical area.

WHO confirms artemisinin resistance in five countries as of February 2015: Cambodia, the Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam. Most patients in these countries with artemisinin resistance survive, provided they receive artemisinin combined with the correct partner drug.

WHO currently recommends five different artemisinin-based combination therapy drug combinations. Many countries are moving towards a fixed-dose system, where one pill contains both medications, to ensure compliance.

How Are ACTs Used?

Routes of administration for artemisinin combination therapy vary, depending on which derivative is used. ACTs using artemether can only be given as an oil-based intramuscular injection or orally while compounds made with artesunate can be taken orally or rectally, or through intramuscular or intravenous routes. Because it is oil-based and water insoluble, arteether may be given by intramuscular injection only.

WHO first recommended and prequalified artemether/lumefantrine as the first fixed-dose artemisinin-based combination therapy for uncomplicated malaria caused by P. falciparum. This ACT has been effective in sub-Saharan Africa as well as in areas with multi-drug resistant P. falciparum in Southeast Asia.

Artemether/lumefantrine is currently the first-line treatment for uncomplicated malaria in many countries but its complex treatment regimen of two doses daily for three days may suppress adherence. A fixed-dose combination of amodiaquine-artesunate became available in February 2007.

The benefits of artemisinin-based combination therapy include:

• High efficacy
• Fast action/
• Reduced risk for the development of resistance

Artemisinin Drugs

Artemisinin has the potential to lower the rate at which resistance emerges and spreads throughout an affected region. In areas of low transmission intensity, ACTs also reduce the overall malaria transmission. More research is still needed to investigate modalities of attaining similar benefits of artemisinin combination therapy approaches in areas of high transmission.

In order to make best use of available malaria treatments, it is critical for practitioners to address issues of delivery, access and cost. In many cases, chloroquine is still the first line treatment for P.vivax and P. ovale, and primaquine effectively treats liver stage parasites of P.vivax.

As drug resistance rises throughout malaria endemic areas, artemisinin-based combination therapy emerges as the best approach to malaria management. Artemisinin compounds combine with other classes of anti-malarial drugs to form highly effective ACTs that may help to delay development of resistance.

Artemisinin combination therapy is an effective prevention and treatment for malaria, especially in cases of infection with artemisinin-resistant strains of malaria.

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