Despite the large number of deaths caused worldwide by AIDS, tuberculosis, and diarrhoeal diseases such as cholera, the biggest infectious-disease killer is still malaria, especially in Africa. Efforts to eradicate the carrier of malaria, a mosquito, have been only partly successful. The standard treatment for malaria has, for many years, been chloroquine, a fairly safe, effective, and cheap drug. Over the 40 years, from the 1940s to 80s, malaria parasites in Africa were highly sensitive to chloroquine. The first case of chloroquine resistance was reported in 1982. In Tanzania, Malawi, South Africa, and Kenya, front-line treatment has been, or is being changed to, a combination of antimalarial drugs - pyrimethamine-sulfadoxine.

Over the past 10 years, there have been many reports that malaria parasites in these countries have become resistant to pyrimethamine-sulfadoxine. An alternative treatment is needed. The difficulties that researchers face in finding an alternative include finding a drug manufacturer willing to provide effective treatments at a price affordable to countries whose funds for purchasing drugs is severely limited: there is no point in effectively testing a wonder drug that no one can pay for.

Dr Theonest Mutabingwa and colleagues from the National Institute for Medical Research in Tanzania tested two antimalarial drugs in a study in northeastern Tanzania, at Muheza, among 360 children less than five years old with falciparum malaria (the most severe form of the disease). The children were first given standard pyrimethamine-sulfadoxine treatment, and if their blood did not clear of parasites within seven days and they later developed a second episode of malaria they were given either a repeat dose of the same treatment or a new combination, chlorproguanil-dapsone. Repeat treatm
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Contact: Richard Lane
richard.lane@lancet.com
44-0-20-7611-4076
Lancet
11-Oct-2001