Plasmodium falciparum remains one of the World's most prevalent and devastating pathogens. Mainly for economic reasons, the parasite's ability to develop resistance to drugs has not been matched by the rate at which new compounds are developed. Even so, there are new drugs (or new combinations of old drugs) currently under investigation, or in the process of development (at the moment):
Pyronaridine, a well-tolerated,
synthetic drug that may have utility for multi-resistant
falciparum malaria in many parts of the world; however,problems remain over the formulation of this
drug (which is a major determinant of its bioavailability) and its eventual cost.
Chlorproguanil-dapsone (lap dap) is being studied as a possible low-cost'successor' to
pyrimethamine-
sulfadoxine; the utility of
chlorproguanil-dapsone as '
salvage' therapy for clinical cases of
pyrimethamine-
sulfadoxine failure has yet to be tested in clinical trials.
Atovaquone-proguanil (
malarone) has utility against multi-resistant parasites; however, it is likely to be expensive (but is currently being provided free-of-charge in certain areas of Africa).
Artemether-benflumetol (coartemether) combines the advantages of
artemether (a rapid reduction in parasite load) with a second
drug that reduces the risk of recrudescence; the cost of this combination is unclear. Rectal
artesunate is being studied as an intervention to reduce the proportion of children with
falciparum malaria who deteriorate to severe disease; the formulation is appropriate for use in rural health centres.