The assessment of antimalarial drug efficacy in-vivo

Currently recommended methods of assessing uncomplicated falciparum malaria treatment work less well in high transmission than in low transmission settings. There is also uncertainty how to assess intermittent preventive therapies and seasonal malaria chemoprevention, and P. vivax radical cure. A “pharmacometric antimalarial resistance monitoring (PARM)” approach is proposed for slowly eliminated antimalarial drugs in areas of high transmission. In PARM antimalarial drug concentrations at recurrent parasitaemia are measured to identify outliers (i.e. recurrent parasitaemias in the presence of normally suppressive drug concentrations), and to characterise changes over time. PARM requires characterization of pharmacometric profiles but should be simpler and more sensitive than current methodologies. PARM does not require parasite genotyping, and can be applied to the assessment of both prevention and treatment.