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Med Hypotheses. 2018 Feb;111:49-54. doi: 10.1016/j.mehy.2017.12.018. Epub 2017 Dec 14.

The role of antimalarial quality in the emergence and transmission of resistance.

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School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide, Australia. Electronic address:
School of Mathematical Sciences, The University of Adelaide, Adelaide, SA, Australia.
Yale School of Public Health, Yale University, New Haven, CT, USA.
Sansom Institute for Research Health, University of South Australia, Adelaide, SA, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, QLD, Australia.


The emergence and transmission of antimalarial resistance is hampering malaria eradication efforts and is shortening the useful therapeutic life of currently available antimalarials. Drug selection pressure has been identified as a contributing factor to the emergence and transmission of resistance, especially population treatment coverage and sub-therapeutic concentrations of active pharmaceutical ingredient (API) in the bloodstream. Medicine quality can be defined as good quality or poor quality. Poor quality antimalarials can be falsified, substandard or degraded and are estimated to make up between 10 and 50% of the antimalarial market in developing countries, and can be a source of sub-therapeutic doses of antimalarial API(s). The availability and use of poor quality antimalarials and the non-recommended use of quality assured monotherapies have historically been linked to treatment failure and in some cases, have coincided with the emergence and transmission of resistance in regions. We propose and outline the hypotheses that the use of poor quality antimalarial treatments and non-recommended quality assured monotherapies promote the (i) emergence and/or (ii) transmission of antimalarial resistance.

[Indexed for MEDLINE]

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