Emilianan Tjitra



Previous approaches in malaria treatment fail to reduce the morbidity and mortality of malaria. Widespread overuse of antimalarial treatment of clinical malaria may have contributed to increase drug resistance. Moreover, poor compliance or inadequate dosage also selects for parasite resistance. The paradigm of radical treatment using drug combinations may improve the cure rate and compliance, thereby preventing or delaying the emergence of parasites resistant to antimalarial drugs. The ideal combined antimalarial regimen in Indonesia should be safe and tolerated by all age groups, effective and rapidly acting for both P.falciparum and P.vivax malaria, short course, good compliance and acceptable, without resistance and/or cross-resistance or , not widely spread use, cost-effective and affordable. Artemisinin derivatives are the best partner drug for combination, with advantages that include: well absorbed, safe and well tolerated, rapidly converted to active metabolite, having very short half-life, broad specificity of action, and extremely potent. Current artemisinin-based combinations which are suitable for Indonesia include: amodiaquine plus artesunate given as single daily dose for 3 days (AQ3+ATS3), mefloquine plus artesunate given as single daily dose for 3 days (MQ3+ATS3), lumefantrine/benflumetol plus artemether given as twice daily dose for 3 days (COARTEMETHER), piperaquine plus dihydroartemisinin given as single daily dose for 2-3 days (PPQ2-3+DHA2-3), and piperaquine plus artemisinin given as single daily dose for 2 days (PPQ2+ATM2). Given the imbalance between rapid development of parasite resistance and slow availability of new effective antimalarial drugs, research and development of antimalarial drugs must be encouraged.


Malaria; Combination therapy; Artemisinin

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Buletin Penelitian Kesehatan (Bulletin of Health Research, p-ISSN: 0125-9695. e-ISSN: 2338-3453) is published by Badan Penelitian dan Pengembangan Kesehatan, Ministry of Health of Republic of Indonesia
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