In Southeast Asia, malaria has become resistant to common artemisinin-based combination therapies over the last decade.

Researchers from the Mahidol Oxford Tropical Medicine Research Unit in Thailand and the Amsterdam UMC recently published the promising results of a large-scale study in that region into the efficacy, safety and tolerability of two forms of triple artesiminin-based combination therapies (TACTs). Internist-infectiologist in training Rob van der Pluijm was research coordinator of this TRAC II study.


Artemisinin and partner drug resistance have resulted in high failure rates of artemisinin-based combination therapies (ACTs) in the GMS. Spread or emergence of resistance beyond the GMS are threats to malaria control.

Triple ACTs (TACTs), combining an artemisinin and two existing partner drugs, could be a stop-gap therapy for treating multidrug-resistant malaria until new antimalarials are available. Where resistance is not established, deployment of TACTs could delay or prevent emergence of resistance and could prolong the longevity of antimalarial compounds used in any triple-drug combination.

TACTs must be safe, well-tolerated, effective, and affordable. Fixed-dose combinations of three drugs in the same tablet will likely improve adherence. Barriers that hinder deployment and adherence must be identified and addressed early in the development of TACTs.