Malaria treatment outcomes in travelers- addressing emerging drug resistance

Malaria is a potentially severe and fatal disease. Artemisinin combination therapy (ACT) is the first line therapy for malaria. Alarming emergence of resistance to artemisinin and partner drugs is now reported from Sub-Saharan Africa.

Understanding treatment outcomes and identifying drug resistant markers could guide management and development of new treatment strategies.

The purpose of this preparatory study is to plan: 1) a nationwide prospective treatment efficacy study using a new standardized follow-up protocol for all malaria patients in Sweden for detecting treatment failures, and 2) to plan a comprehensive prospective study in adults treated for Plasmodium falciparum malaria with more extensive sampling to assess parasite clearance time in relation to antimalarial drug concentrations, host immunity and parasite genomics.

Within the preparatory study, we will assess current practice of diagnostics and management of malaria across Sweden.

Moreover, we will perform a retrospective review of treatment outcomes since ACT was introduced, and also perform a pilot analysis of resistance mutations in available archived samples.

The project involves experts in infectious diseases, pediatrics, microbiology and pharmacology; and the aim is to establish a nationwide collaborative network including all treating clinics.

The findings from this project will lead to improved management and monitoring of malaria in travelers, and could also inform treatment strategies in endemic areas.