A report released yesterday by a United States Pharmacopeia program, in partnership with the World Health Organization, cited an increasing level of resistance to Artemisinin — the last affordable drug in the global arsenal against malaria.  The drug resistance is emerging in Uganda, Senegal, Madagascar, Cambodia, Thailand and Vietnam, and is thought to be due in large part to the sale of poor quality versions of Artemisinin in those countries.

The report indicated that between 16 and 40 percent of the drugs marketed as Artemisinin had impurities or did not contain enough active ingredient to be effective.  Drugs will typically lose effectiveness and allow parasites to develop resistance if not given at full strength or for the full recommended course. In the case of malaria, there is no useful replacement for Artemisinin currently available, and many could die or become gravely ill if the current trend continues.

“It is worrisome that almost all of the poor quality data that was obtained was a result of inadequate amounts of active ingredient or the presence of impurities in the product” said Patrick Lukulay, the director of the study.  Senegal had the most disturbing results, with over 40% of the Artemesisin based samples failing quality testing. Lukulay added “There are some countries where donated medicines are not subjected to quality controls, they are just accepted”.  This includes countries in Africa where Chinese products have been given and found later to be unacceptable.

Although results from other countries in the ten country study have not been released, preliminary evidence from the other countries surveyed — Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania suggest that failure rates in at least three of those countries were also high.

Traditional antimalarial drugs such as malarone, doxycycline, chloroquin and mefloquin are still effective in many parts of the world where the malaria parasite is endemic.  In recent years, Artemesinin has been the last resort in areas where the parasite has developed resistance to these medications. However, for those travelling to sub Sahara Africa or southeast Asia, the risk of contacting Artemesinin resistant malaria is growing.  Although resistance is not yet widespread, it behooves the careful traveler to make sure that any Artemesinin based medication taken for treatment of a malaria infection is of good quality.



About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

1 Comment

  1. Important information to assist travelers in advance of their departure.

    A pre-departure consultation with your physican about appropriate vaccinations might also include a discussion about malaria prevention medications.

    The CDC has a chart that offers a list of recommended medications by destination that can be taken to prevent malaria.

    See this link:
    http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria-risk-information-and-prophylaxis.aspx to be prepared.

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