Early treatment of malaria in the community using artemisinin--hope or hazard?

Most malaria morbidity and mortality occurs in the community. Treatment aimed at managing patients at this level of the health care system should bring health and economic benefits to the population. Artemisinin suppositories have been successfully used in adults and children to treat, uncomplicated and complicated malaria. Their use early in the course of the disease may reduce complications and patient referral to tertiary care hospitals. A single dose of artemisinin followed by a single dose of mefloquine, given at the household or hamlet level, may be a therapeutic approach that has advantages for developing countries. However, widespread and uncontrolled use of artemisinin could result in unexpected and undesirable side-effects, improper dose schedules and poor compliance which, in turn, might cause primary treatment failures, recrudescences, and possibly resistance to the drug. Such problems can be avoided or managed by regulating and monitoring its use.