*5.4. Artemisinin-Based Combination Therapies*

As discussed earlier, quinolines and artemisinins act essentially via the production of ROS. The WHO has recommended six artemisinin-based combination therapies (ACTs): artemether–lumefantrine (AL), dihydroartemisinin–piperaquine (DHA-PPQ), artesunate– amodiaquine (AS-AQ), artesunate–mefloquine (AS-MQ), artesunate–sulfadoxine-primetha mine (AS-SP), and artesunate–pyronaridine (AS-PY) [120]. ACTs drastically clear the parasite and resolve malaria symptoms (such as fever) [121], hence the need for their continued use. Synthetic hybrids of endoperoxides and quinolines have been developed to enhance their pharmacological activities and cost-effectiveness in malaria treatment [105,122]. Resistance to partner drugs used in ACTs in Southeast Asia raises concern over the long-term usefulness of these antiplasmodial combinations [120,123,124].
