Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach

Malaria Journal

Research

Ian Hastings¹  Tiago Antao² 

[1] Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK;Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK;Wellcome Trust Centre for Human Genetics, University of Oxford, OX37BN, Oxford, UK;

关键词: Malaria;    Plasmodium falciparum;    Drugs;    Resistance;    Treatment;    Policy;    Adherence;   

DOI  :  10.1186/1475-2875-11-422

 received in 2012-10-31, accepted in 2012-12-08,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundAnti-malarial drugs are constantly exposed to the threat of evolving drug resistance so good stewardship of existing therapy is an essential component of public health policy. However, the widespread availability of numerous different drugs through informal providers could undermine official drug deployment policies. A policy of multiple first-line therapy (MFT) is compared with the conventional policy of sequential drug deployment, i.e., where one drug is used until resistance evolves and then replaced by the next drug in the sequence.MethodsPopulation genetic models of drug resistance are used to make the comparison; this methodology explicitly tracks the genetics of drug resistance (including, importantly, recombination in the sexual stage, intrahost dynamics, and direction of linkage disequilibrium).ResultsA policy of MFT outlasts sequential application providing drug usages are low to moderate, and appears not to drive widespread multi-drug resistance. Inadequate dosing is an even more potent driver of drug resistance than the MFT/sequential policy decision.ConclusionsThe provision of MFT as a deliberate policy can be encouraged provided overall treatment rates are low or moderate (less than around half of malaria infections are treated) and the ad hoc provision of MFT through the private sector may be tolerated. This must be fully supported by education to ensure people take adequate doses of each of the drugs.

【 授权许可】

CC BY   
© Antao and Hastings; licensee BioMed Central Ltd. 2012