Chapter 12 : A Reasonable Dream

Abstract:

Control of malaria on a global scale will require good intentions plus a combination of interventions and a substantial investment of money. Mosquito control is an important element in reducing transmission. Although hope remains for a protective vaccine, the goal is still elusive. Most antimalarial drugs now in use were not developed on the basis of rationally identified targets, but follow accidental findings of antimalarial activity in natural products or chemically related molecules or medicines that are active against other microbes. The serendipitous discovery of quinine remains a landmark in the use of magic bullets to cure malaria. A 7-day course of quinine monotherapy had an efficacy of 92% in Bangladesh and 95% in Venezuela against P. falciparum but was less effective in western Thailand (67%) and Bangkok (80%). By 1925 German pharmaceutical industry had discovered pamaquine (plasmochin), the first clinically acceptable (but toxic) synthetic antimalarial based on modifications of the aniline dye methylene blue. Piperaquine was used in a variety of combinations in Vietnam and China in the 1990s with high cure rates. Originally, the formulation (CV4) had four components: primaquine, trimethoprim, piperaquine, and dihydroartemisinin (DHA). Many malaria workers believe that control of malaria, with a reduction of its attendant burdens, can be achieved by means of insecticide-impregnated bed nets, residual insecticides, and medicines. The challenge for the future will be to develop new, affordable, convenient, safe, and tolerable drugs for control to succeed.