Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, UK.
Br J Clin Pharmacol. 2022 Feb;88(2):374-382. doi: 10.1111/bcp.14474. Epub 2020 Aug 1.
The deployment of artesunate for severe malaria and the artemisinin combination therapies (ACTs) for uncomplicated malaria has been a major advance in antimalarial therapeutics. These drugs have reduced treated mortality, accelerated recovery and reduced treatment failure rates and transmission from the treated infection. Artemisinin derivatives remain highly effective against falciparum malaria in most malaria endemic areas, but significant resistance has emerged in the Greater Mekong subregion of Southeast Asia. Resistance to artemisinins was followed by resistance to the ACT partner drugs, and fit multidrug resistant parasite lineages have now spread widely across the region. ACTs remain highly effective against P. vivax and the other malaria species. Recent studies have shown that radical curative regimens of primaquine (to prevent relapse) can be shortened to 7 days, and that the newly introduced single dose tafenoquine is an alternative, although the currently recommended dose is insufficient in Southeast Asia and Oceania. Targeted malaria elimination using focal mass treatments with dihydroartemisinin-piperaquine have proved safe and effective malaria elimination accelerators, but progress overall towards malaria elimination is slow. Indeed since 2015 overall malaria case numbers globally have risen. As new drugs will not become widely available in the near future, active measures to preserve the current antimalarials should be given the highest priority.
青蒿琥酯用于治疗重症疟疾和青蒿素类复方疗法（ACT）用于治疗无并发症疟疾，这是抗疟治疗的重大进展。这些药物降低了病死率，加快了康复速度，降低了治疗失败率，并减少了从治疗感染中传播的可能性。在大多数疟疾流行地区，青蒿素衍生物对恶性疟原虫仍然非常有效，但在东南亚大湄公河次区域已经出现了明显的耐药性。对青蒿素的耐药性随后导致对 ACT 联合用药的耐药性，现在适合多药耐药的寄生虫谱系已广泛传播到该地区。ACT 对间日疟原虫和其他疟原虫仍然非常有效。最近的研究表明，伯氨喹的根治性治疗方案（预防复发）可以缩短至 7 天，新引入的单剂量tafenoquine 是一种替代药物，尽管目前推荐的剂量在东南亚和大洋洲不足。使用双氢青蒿素-哌喹进行有针对性的群体治疗以消除疟疾，已被证明是安全有效的疟疾消除加速剂，但总体而言，疟疾消除的进展缓慢。事实上，自 2015 年以来，全球疟疾病例总数有所上升。由于新药在不久的将来不会广泛上市，因此应高度优先考虑采取积极措施来保护现有的抗疟药物。
