As Since ACTs are rapidly metabolised, a recent

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being implemented in Cambodia, the following may be considered: (a) Sequential
deployment of two different ACTs and/or increase in the duration of dosage of
one type of ACTJG1  in
Cambodia 46, (b) use of triple drug strategy i.e ART with two partner drugs 96, (c) inclusion of gametocidal drugs including
piperaquine or primaquine as in Cambodia and Senegal 52, 96-99, (d) A
multi-centric study showed that 100 mg and 200 mg of arterolane (OZ277;
derivative of trioxolane) daily is safe and efficacious to be used as potential
anti-malarial in combination with other partner drugs 100. Further clinical
trial conducted to study the use of arterolane–piperaquine combination found
that combination is effective under fixed dose combinationJG2 . The
combination is already registered in India for use 101. Although highly
efficacious, most of Kelch 13 mutants were resistant to arterolaneJG3 . Newer
derivatives OZ439 were found to be effective against Kelch13 mutant parasite
lines 102. Thus clinical trials are required to be conducted using OZ439 in
combination with partner drugs. Since ACTs are rapidly metabolised, a recent
study by Puttapa et. al from India
has proposed the use of self-nanoemulsifying drug delivery system (SNEDDS) to
deliver artesunate and quercetin/luteolin for malaria treatmentJG4 . The
system if successful will lead to the reduction in drug dosage and thus
increase in patient compliance and thus lead to better treatment 103. Initial
trials by Mustafa et. al showed
single dose of ART–naphthoquine to be effective in initial trials, although
further clinical trials are required before it is introduced under medical
policies 104. These altered clinical
approaches to handling of malaria cases in high risk regions within India may
help delay the possible appearance of full blown ART resistance – hopefully
till the time new anti-malarial drugs based on novel scaffolds/pathways have
been launched.

mention all authors for subsequent points or don’t mention at all.


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