Antimalarial Drug Resistance: In the Past, Current Status and Future Perspectives

The aim of this study was to review the antimalarial drug treatment and its resistance during the course of therapy. Malaria affects the populations of tropical and subtropical areas world-wide, as well as an increasing number of travellers to these areas. Although malaria is found in over 100 countries, the major burden of disease is carried by the nations of Africa, where over 90% of all deaths from falciparum malaria are recorded and where the high levels of morbidity and transmission place considerable strains on public health services and economic infrastructure. In the absence of effective vaccines, management of the disease has depended largely upon chemotherapy and chemoprophylaxis. The number of available and effective antimalarial drugs is quickly dwindling due to different cause. This is mainly because a number of drug resistance-associated mutations in malaria parasite genes, such as crt, mdr1, dhfr/dhps and others, have led to widespread resistance to all known classes of antimalarial compounds. Unfortunately, malaria parasites have started to exhibit some level of resistance in Southeast Asia even to the most recently introduced class of drugs, artemisinins. Molecular evolutionary and population genetic approaches will greatly facilitate our understanding of the evolution and spread of parasite drug resistance and will contribute to developing strategies for better control of malaria. While there is much need, the antimalarial drug development pipeline remains woefully thin, with little chemical diversity and there is currently no alternative to the precious artemisinins. In general, four basic methods have been routinely used to study or measure antimalarial drug resistance: in vivo, in vitro, animal model studies and molecular characterization. This review endeavors to present the background facts and treatment and more on the current status of antimalarial drug resistance, what their causes, mechanisms, spread and management are and future perspective with antimalarial treatment. Furthermore, findings from this review will be useful to clinical researchers, health planners, policy makers and stakeholders and others concerned for malaria patients.