Artemisinin derivatives for treatment of uncomplicated Plasmodium falciparum malaria in Sudan: too early for too much hope.

The artemisinin-based combination therapy (ACT) is adopted by several countries as first line for malaria treatment in the last decade. Concomitantly, the World Health Organization and other research reports showed a dramatic decline in malaria burden in terms of morbidity, mortality and treatment failure (TF). The optimistic features of ACT are regularly reported with great hopes, while the pessimistic facets either not existing or underreported. However, the dependence on ACT as a single chemotherapeutic agent for malaria control bears considerable risks. Occurrence and spread of artemisinin derivatives (AD) TF will be a major threat, whether it is due to parasite drug resistance or use of poor drug quality. In addition, the safety of AD is not yet fully known. In this short review, two clinical trials performed to evaluate the efficacy and safety of AD, dihydroartemisinin (DHA) plus chloroquine and artesunate (AS) plus fansidar, in Sudan are critically discussed. The conclusions from both studies were that, the TF rate of DHA indicates arrival of counterfeit AD to Africa, and both rate of TF and undesirable effects of AS/SP were recognized. Both findings indicate that it is too early for too much hope on AD.