สำนักราชบัณฑิตยสภา

The Journal of the Royal Institute of Thailand Volume II - 2010 Combination Anti-malarial Therapy and WHO Recommendations 100 Combination Anti-malarial Therapy and WHO Recommendations Prakaykaew Charunwatthana 2 , and Sasithon Pukrittayakamee 1,2 1 Associate Fellow of the Royal Institute, Academy of Science 2 Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Thailand Abstract Malaria infection is a major global health problem causing at least 1 million deaths per year. P. falciparm parasite in many areas has developed resistance to antimalarial monotherapy. The use of antimalarial combinations will delay the onset and slow the rate of spread of resistance. WHO recommends that all countries experiencing resistance to conventional monotherapies, such as chloroquine, quinine, amodiaquine or sulfadoxine–pyrimethamine, should use combination therapies, preferably those containing artemisinin derivatives or artemisinin-based combination therapies. Other alternative combination therapies are artesunate plus tetracycline or doxycycline or clindamycin and quinine plus tetracycline or doxycycline or clindamycin. Key words: Malaria, Combination therapy Introduction Malaria remains the most important parasitic infection of man. Each year, 300-500 million of the world’s population are infected and 1-3 million people die from malaria infection. The development of drug resistance in both falciparum and vivax malaria, the two most important forms of human malaria, will further increase the already massive burden of morbidity and mortality from malaria (Figure 1, Pukrittayakamee & White, 2002; WHO, 2010) Plasmodium falciparum parasite in many tropical countries has developed resistance to many major antimalarial drugs: chloroquine, sulfadoxine-pyrimethamin, quinine and mefloquine (Figure 2). The artemisinin derivatives have been used extensively in Vietnam and Thailand over the past few years and P. falciparum has recently shown reduced in vivo susceptibility to artesunate in western Cambodia as