Global Health Journal Club Outbreaks and Updates Travel Health Tropical Medicine

Artemisinin resistant malaria in Cambodia: counterfeit drugs to blame?

Artemisia abrotanumArtemisinin is considered the best weapon the world has in the war against severe malaria.  This humble, plant derived medicine comes from the quinghasou (sweet wormwood) plant and has been used for centuries to combat malaria.  Unfortunately, it is becoming less and less effective.

Pro-Med reports an interesting and scary case of a teacher in the Battambang province in Cambodia who has been treated with artemisinin and is still showing malaria parasites in his blood.  Unfortunately, this patient is not the only one showing resistance.  Typically, malaria parasites are killed in 2-3 days when using artemisinin.  The patients in question are participating in a US Armed Forces Research program and the researchers report that approximately 1/3 to half of the 90 patients involved in the trials are still positive for malaria parasites, days after being treated with artemisinin.

Southeast Asia, particurlarly on the Cambodia and Thailand border regions, has long been know as a “front-line” battle against drug resistant malaria.  Drug resistant malaria strains are known to occur here and several of those strains have originated in this specific area.  Many factors contribute to a resistance of a parasite or bacteria to a certain medicine.  Why this specific area produces so much resistance is being questioned.

Drug resistance: Why?

Many theories exist as to why this geographic region produces so many resistant strains.  Some of the top ideas focus on the counterfeit drug trade in South East Asia and lack of proper medical supervision when taking anti-malarials.  All pharmacies should be licensed and approved to dispense accurately labeled medicine.  However, many pharmacies operate without licenses and dispense anti-malarial medicine with little or no actual medicine.  These “market stands” often appear in road-side markets between clothing retailers and food stands.  Often, they offer a better price than reputable pharmacies and are frequently used by travelers and locals, alike. 

The concern with receiving anti-malarials with little actual medicine is that the tablets contain just enough active ingredient to allow the parasite to develop resistance, without actually killing them.  In addition, using mono-therapy with artemisinin alone is very risky and may further contribute to this resistance problem. 

Advice for the traveler:

Travelers to this area of the world need to be informed of not only the possibility of artemisinin resistant malaria but also the counterfeit drug trade.  Reputable pharmacies should only be used and the traveler should inquire if they have a proper license.  Trying to save a few bucks on discount malaria medication is just plain crazy and similar to buying a discount helmet.  When I bought a motorcycle helmet, I was asked if I had a $20 head of a $200 head.  Somethings are not ment to be scrimped on.

Adventurers in the area who suspect they have malaria (fever, chills) should also seek qualified medical treatment and not attempt to self-treat unless this specific option was previously discussed with their travel doc.


Artemisia plants encompass about 200-400 different species and only a few species contain effective quantities of medicine to fight malaria.  A few other sues of Artemesia species include making the popular drink Absinthe and the cooking herb Tarragon.

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