Piperaquine Resistance in Kenya: A Mini Review Following the Rollout of Duo-Cotecxin® as SecondLine Treatment for Uncomplicated Malaria

Duo-cotecxin® is the second-line antimalarial drug for the treatment of uncomplicated malaria in Kenya.It is an artemisinin combined therapy (ACT) made up of dihydroartemisin and piperaquine (DHA-PPQ).This drug has shown good efficacy in chemotherapy, seasonal chemoprevention, and intermittent preventive treatment (IPT) of uncomplicated malaria.However, reports on emergence of DHA-PPQ resistance in Southeast Asia and later in South America have been attributed to the failing PPQ and artemisinin derivative efficacy.These findings, alongside recent increasing reports of partial artemisinin resistance in African countries, namely; Rwanda, Uganda, Eritrea, Tanzania, Ethiopia, Sudan, Namibia, and Zambia threaten the continued use of artemisinin-based combination therapy partner drugs such as piperaquine and lumefantrine in Kenya and across sub-Saharan Africa.Therapeutic efficacy studies (TES), molecular analyses, and in vitro/ex vivo drug susceptibility assays are the recommended tools for monitoring antimalarial drug resistance.Here, we review the existing literature on piperaquine resistance in Kenya utilizing TES, molecular signatures and in vitro/ex vivo susceptibility studies.Literature search was conducted on Scopus, PubMed, and Google Scholar databases using key words "piperaquine resistance in Kenya" or "antimalarial resistance in Kenya."Only articles written in English were included in the mini-review.We highlight the probable mode of action of PPQ, the molecular mechanism of piperaquine resistance, and the effectiveness of piperaquine against uncomplicated P. falciparum malaria.Efforts to strengthen the utilization of molecular and piperaquine survival assays as surveillance tools in Kenya are needed in order to adequately inform on piperaquine resistance as DHA-PPQ deployment increases in the Country amidst evolving artemisinin partial resistance.