Concerned over growing incidence of drug resistance to the mono therapy for malaria in India, the World Health Organisation (WHO) has asked the Centre to phase out mono therapy for malaria in the country. It has asked the health authorities in the country to introduce ACT (Artesunate-Sulpha-Pyrimethamine) combination therapy which has been accepted worldwide.

A high level meeting to take stock of the malaria infection in the country was held recently under the initiative of WHO in which senior health officials including Director General of Health Services, Drug Controller General of India and senior officials from the National Institute of Malaria Research (NIMR) were present. The meeting discussed the measures to be taken to phase out the mono therapy for malaria disease in the country.

In the meeting, expressing concern over the reports of drug resistance to the malarial drugs, the WHO stressed the advantages of introducing ACT therapy. Apart from giving better results, the ACT therapy's duration is also lower than the mono therapy. But, the cost of the treatment will go up.

According to sources, the mono therapy for malaria will be discontinued from the country in a phased manner in the next six to nine months and the ACT therapy will be introduced. DCGI has been asked to give permission to the drug companies in the country for manufacturing anti-malarial combination drugs in consultation with NIMR. So far, only Cipla has been given permission to manufacture anti-malarial combination drugs in the country for domestic use.

Though India is one of the largest producers and exporters of anti-malarial combination drugs, DCGI did not allow its usage in the country on safety concerns. Cipla, Plethico Pharma, Vital Healthcare, Ipca, Themis Medicare, etc are the major players in this category of drugs. The anti-malarial combination drugs are accepted worldwide including almost all African countries where the incidence of malaria cases is reported more than any other region.

According to NIMR, malaria is one of the major public health problems of the country. Around two million laboratory confirmed cases of malaria are reported in the country annually. Out of the total malaria cases, 40-50 per cent is P.falciparum. The P.falciparum species is spreading wider due to migration of population from endemic to non endemic areas and vice versa has increased tremendously. One of the reasons attributed to rise in P.falciparum is resistance to drug chloroquine, which is being used as a first line of treatment for malaria cases.

During recent years, it has been observed that chloroquine resistance is widely spread as per the results of the drug sensitivity studies conducted in the country. This is a serious concern to the programme as this species is responsible for mortality. It is observed that P.falciparum infection may lead to complications in 0.5 per cent to 2 per cent of cases. Mortality may result in about 30 per cent of such cases if timely treatment is not given. Use of an appropriate anti malaria drug is very important not only to save the life of patients suffering from P.falciparum but also to contain the spread of this species.