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Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Plasmodium falciparum Malaria and Artemisinin Resistance

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Drug resistance is a feared sequel to using drugs to treat infectious diseases. To think about it simplistically, a germ (virus or bacteria) exposed repeatedly to a drug evolves on or more mechanisms to resist the germ-killing effects of the drug. "Penicillin resistance" implies that a particular bacteria is able to withstand exposure to penicillin; "methicillin resistant Staphylococcus aureus" is a strain of the Staphylococcus bacteria that has evolved resistance to the (formerly effective) drug methicillin.

Falciparum malaria can be a deadly disease, and is a scourge of mankind. Artemisinin-based combination drug therapies are recommended first-line treatments for falciparum malaria in all countries with endemic malaria. However, it has been observed that the effectiveness of such treatments has declined on the border between Thailand and Cambodia. If this is the case, the resistance will likely spread.

In an article (New England Journal of Medicine 2009;361:455-67) entitled "Artemisinin Resistance in Plasmodium falciparum Malaria," Arjen Dondorp, MD and colleagues compared the effectiveness of two treatments for uncomplicated falciparum malaria in western Cambodia and northwestern Thailand. The conclusion was that P. falciparum is not as susceptible (as measured by parasite clearance from the bloodstream) to artesunate in western Cambodia as in northwestern Thailand. The implications are very important. At least one very important approach should be entertained in this situation - a containment strategy - to try to limit the spread of the disease by controlling the affected mosquito population. Since artemisinin administration is replacing quinine as a primary therapy, resistance to this drug would be disastrous to control of malaria worldwide.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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