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

<p>Abstract</p> <p>Background</p> <p>Anti-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 differen...

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Main Authors: Antao Tiago, Hastings Ian
Format: Article
Language:English
Published: BMC 2012-12-01
Series:Malaria Journal
Subjects:
Online Access:http://www.malariajournal.com/content/11/1/422
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spelling doaj-5027983e96dd482a966ca13a2275e7302020-11-24T21:13:57ZengBMCMalaria Journal1475-28752012-12-0111142210.1186/1475-2875-11-422Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approachAntao TiagoHastings Ian<p>Abstract</p> <p>Background</p> <p>Anti-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.</p> <p>Methods</p> <p>Population 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).</p> <p>Results</p> <p>A 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.</p> <p>Conclusions</p> <p>The 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 <it>ad hoc</it> 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.</p> http://www.malariajournal.com/content/11/1/422MalariaPlasmodium falciparumDrugsResistanceTreatmentPolicyAdherence
collection DOAJ
language English
format Article
sources DOAJ
author Antao Tiago
Hastings Ian
spellingShingle Antao Tiago
Hastings Ian
Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
Malaria Journal
Malaria
Plasmodium falciparum
Drugs
Resistance
Treatment
Policy
Adherence
author_facet Antao Tiago
Hastings Ian
author_sort Antao Tiago
title Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
title_short Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
title_full Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
title_fullStr Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
title_full_unstemmed Policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
title_sort policy options for deploying anti-malarial drugs in endemic countries: a population genetics approach
publisher BMC
series Malaria Journal
issn 1475-2875
publishDate 2012-12-01
description <p>Abstract</p> <p>Background</p> <p>Anti-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.</p> <p>Methods</p> <p>Population 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).</p> <p>Results</p> <p>A 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.</p> <p>Conclusions</p> <p>The 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 <it>ad hoc</it> 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.</p>
topic Malaria
Plasmodium falciparum
Drugs
Resistance
Treatment
Policy
Adherence
url http://www.malariajournal.com/content/11/1/422
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