Malaria drugs fail for first time on patients in UK

A key malaria treatment has failed for the first time in
 patients being treated in the UK, doctors say.

The drug combination was unable to cure four patients,
 who had all visited Africa, in early signs the parasite
 is evolving resistance.

A team at the London School of Hygiene and Tropical Medicine said it was too early to panic.

But it warned things could suddenly get worse and
 demanded an urgent appraisal of drug-resistance 
levels in Africa.

Malaria parasites are spread by bites from infected mosquitoes.

It is a major killer of the under-fives with one child dying 
from the disease every two minutes.

Between 1,500 and 2,000 people are treated for malaria 
in the UK each year - always after foreign travel.

Most are treated with the combination drug: artemether-
lumefantrine.

But clinical reports, now detailed in the journal 
Antimicrobial Agents and Chemotherapy, showed the
 therapy failed in four patients between October 2015
 and February 2016.

All initially responded to therapy and were sent home, 
but were readmitted around a month later when the
 infection rebounded.

Samples of the parasite that causes malaria were analysed 
at the Malaria Reference Laboratory at the London School 
of Hygiene and Tropical Medicine.

Dr Colin Sutherland told the ERIC GOSSIP: "It's 
remarkable there's been four apparent failures 
of treatment, there's not been any other published 
account [in the UK]."

All of the patients were eventually treated using other therapies.

But the detailed analysis of the parasites suggested
 they were developing ways of resisting the effects 
of the front-line drugs.


 Medically Challenging 


Dr Sutherland added: "It does feel like something is 
changing, but we're not yet in a crisis.

"It is an early sign and we need to take it quite seriously
 as it may be snowballing into something with greater 
impact."

Two of the cases were associated with travel to Uganda, 
one with Angola and one with Liberia - suggesting
 drug-resistant malaria could be emerging over wide 
regions of the continent.

Dr Sutherland added: "There has been anecdotal evidence 
in Africa of treatment failure on a scale that is clinically challenging.

"We need to go in and look carefully at drug efficacy."

The malaria parasites all seemed to be evolving 
different mechanisms rather than there being one new
 type of resistant malaria parasite spreading through
 the continent.

The type of resistance is also clearly distinct from the
 form developing in South East Asia that has been 
causing huge international concern.

Dr Sutherland says doctors in the UK need to be 
aware the drugs might not work and argued current 
treatment guidelines may need to be reviewed.

Professor David Lalloo, Dean of Clinical Sciences and International Public Health at Liverpool School of 
Tropical Medicine, said more studies are needed.

"This is an interesting and well conducted study and
 again emphasises the incredible ability of the malaria
 parasite to rapidly evolve to become resistant to
 antimalarial treatment," he said.

"It is too early to fully evaluate the significance of
 these findings but the paper highlights the need
 to be constantly vigilant when treating patients with 
malaria and larger studies are certainly needed to 
explore this issue further."