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As Since ACTs are rapidly metabolised, a recent

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Asbeing implemented in Cambodia, the following may be considered: (a) Sequentialdeployment of two different ACTs and/or increase in the duration of dosage ofone type of ACTJG1  inCambodia 46, (b) use of triple drug strategy i.e ART with two partner drugs 96, (c) inclusion of gametocidal drugs includingpiperaquine or primaquine as in Cambodia and Senegal 52, 96-99, (d) Amulti-centric study showed that 100 mg and 200 mg of arterolane (OZ277;derivative of trioxolane) daily is safe and efficacious to be used as potentialanti-malarial in combination with other partner drugs 100. Further clinicaltrial conducted to study the use of arterolane–piperaquine combination foundthat combination is effective under fixed dose combinationJG2 . Thecombination is already registered in India for use 101.

Although highlyefficacious, most of Kelch 13 mutants were resistant to arterolaneJG3 . Newerderivatives OZ439 were found to be effective against Kelch13 mutant parasitelines 102. Thus clinical trials are required to be conducted using OZ439 incombination with partner drugs. Since ACTs are rapidly metabolised, a recentstudy by Puttapa et. al from Indiahas proposed the use of self-nanoemulsifying drug delivery system (SNEDDS) todeliver artesunate and quercetin/luteolin for malaria treatmentJG4 .

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Thesystem if successful will lead to the reduction in drug dosage and thusincrease in patient compliance and thus lead to better treatment 103. Initialtrials by Mustafa et. al showedsingle dose of ART–naphthoquine to be effective in initial trials, althoughfurther clinical trials are required before it is introduced under medicalpolicies 104.

These altered clinicalapproaches to handling of malaria cases in high risk regions within India mayhelp delay the possible appearance of full blown ART resistance – hopefullytill the time new anti-malarial drugs based on novel scaffolds/pathways havebeen launched. JG1Eithermention all authors for subsequent points or don’t mention at all. JG2REFERENCE JG3REFERENCE JG4REFERENCE

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