Antimalarial Drugs and Drug Resistance

WHO estimated 241 million malaria cases in 2020 in 85 different malaria-endemic countries, more than in 2019. The reduction of cases due to Plasmodium vivax from about 8% (18.5 million) in 2000 to 2% (4.5 million) in 2020 was also observed (WHO, WHO malaria report. WHO, Geneva, 2021). Of the five species causing malaria in humans, Plasmodium falciparum remains a significant threat globally. An increase in antimalarial resistance is a global health concern. Antimalarial drugs developed over the past 60 years have rendered survival pressure over the human malaria parasite. Drug resistance progressing in sub-Saharan Africa, which bears >90% of the global malaria burden, is causing a major threat to the WHO malaria control program. According to the WHO Global technical strategy for malaria (2016–2030), despite the factors stalling the progress of the control program, examples such as many people needing help to access health services, progress made in high-burden countries have reduced the transmissions in low level. Exploring the high burden to high impact approach is proving to be efficient and reliable when implying new interventions. The fight against malaria is still ongoing; thus, novel treatments are very much required to face the consequences of drug resistance. The advances in molecular surveillance tools, bioinformatics, translational genomics, and malaria chemotherapy have provided more insight into drug resistance worldwide. This chapter will focus on the implications of antimalarial drug resistance and how the progress made in parasitology regarding genomic analysis and pharmacology helps us understand the paradigm for optimizing existing and novel treatments for severe malaria.