Background information

Continuing to treat patients with failed or failing antimalarial drugs is a major and unnecessary cause of mortality. The introduction of artemisinin-based combinations may reverse that trend, but resistance to these drugs will evolve eventually. WHO now recommends that review and change of the antimalarial treatment policy should be initiated when the cure rate with the current recommended medicine falls below 90% (as assessed in the course of surveillance monitoring, preferably with at least 28 days of follow up) and the new recommended treatment should have an average cure rate of >= 95% as assessed in clinical trials. It is crucial to establish and maintain close surveillance as new drugs are introduced so that they will have the maximum useful therapeutic life. The first step is to assemble and integrate the information now available as a comprehensive real-time database that is accessible to all. Postponing this synthesis will only make it harder to integrate the current information. It is imperative to act now to make the community decisions that will initiate this effort.