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Between 1998 and 2001, the Peruvian Ministry of Health made sweeping changes in its malaria treatment policies in response to a resurgence of disease and the spread and intensification of antimalarial drug resistance. On the Pacific Coast, the first-line treatment for uncomplicated Plasmodium falciparum malaria was changed to combination therapy with sulfadoxine- pyrimethamine plus artesunate; in the Amazon region, mefloquine-artesunate combination therapy was introduced. With these changes in treatment policy, Peru became the first country in the Americas to use combination therapy with an artemisinin drug as its first-line treatment for falciparum malaria and the first country in the world to use two different drug combination therapy regimens based on an artemisinin drug in different regions of the country. This paper describes the process involved in assessing the geographic distribution and intensity of antimalarial drug resistance throughout the country and the use of that information to guide decisions related to national malaria treatment policy. [ABSTRACT FROM AUTHOR]

During the 1990 decade Peru experienced malaria re-emergence in the Amazon Basin and in the northern coast of its territory, and the occurrence and extension of Plasmodium falciparum resistance to antimalarial drugs in both geographical areas were simultaneously observed. The Ministry of Health faced the problem strengthening the available control measures and performing research in order to better determine the geographical extension and the intensity of the resistance to antimalarial drugs, with the purpose of reviewing and adjusting the treatment policies facing this emergent sanitary condition in the country. A review of the Ministry of Health changes in the treatment policies against malaria between 1990 and 2001 is presented, focusing that currently a new therapy including one drug of the arthemisine family for the treatment of P. falciparum was implemented. Due to this change in antimalarial treatment policiy, Peru is currently the first country in America using combination therapy including arthemisine as a first line treatment for non complicated P. falciparum malaria. The Peruvian experience is shown as a model for other countries in the region which also face drug-resistant P. falciparum malaria emergence [ABSTRACT FROM AUTHOR]