Malaria remains a global health threat for centuries. In recent years, a rising resistance of Plasmodium falciparum to current standard artemisinin-based combination therapies (ACTs) leads to increasing treatment failures and requires for optimized treatment. Here, we intend to make a systematic review and meta-analysis of optimizing treatment for malaria, so as to find a potential optimal treatment.
Delayed clearance of Plasmodium falciparum by artemisinin-based combination therapies (ACTs) has already been observed in African isolates. Here, we aimed to investigate the prevalence of polymorphisms in two genes correlated with delayed parasite clearance, P. falciparum Kelch 13 (PfK13) and ubiquitin-specific protease 1 (pfubp1), among returning travellers from African countries reported in eastern China and to provide baseline data for antimalarial drug resistance (ART) surveillance and evaluation.
Artemisinin-based combination therapies (ACTs) have been recommended by the World Health Organization (WHO) as first-line treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria since 2005 in Democratic Republic of Congo (DRC) and a regular surveillance of the ACT efficacy is required to ensure the treatment effectiveness. Mutations in the propeller domain of the pfk13 gene were identified as molecular markers of artemisinin resistance (ART-R).
In the absence of an effective vaccine, the efficacy of antimalarial chemotherapies underpins the success of malaria control programmes. Artemisinin-based combination therapies (ACTs), which combine fast-acting artemisinin derivatives and longer-acting partner drugs, are the mainstay of treatment of uncomplicated falciparum malaria in endemic regions.
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.
Quiescence is an unconventional mechanism of Plasmodium survival, mediating artemisinin resistance. This phenomenon increases the risk of clinical failures following artemisinin-based combination therapies (ACTs) by slowing parasite clearance and allowing the selection of parasites resistant to partner drugs.