Falciparum malaria: current therapeutic challenges.
OBJECTIVE
Malaria remains a major cause of death in much of the world. The routine treatment of malaria is currently threatened by rising rates of drug resistance. Moreover, mortality among children with severe and complicated malaria remains unacceptably high. Here we review trends in antimalarial drug resistance and report on the progress of newer drugs and drug combinations. We then review some recent literature regarding the pathological processes involved in the aetiology of severe malaria that may lead to improvements in the management of children with severe disease.


RESULTS
Resistance to first line therapies, including chloroquine and sulphadoxine/pyramethamine, continues to rise in many parts of the world. The availability of newer and more effective drugs and fixed drug combinations is hampered by financial and political considerations. Nevertheless, a number of promising drugs and supportive treatments for both mild and severe malaria are at various stages of development.


CONCLUSIONS
A range of newer drugs and fixed drug combinations are now available that are safe and effective. However, these drugs remain expensive and their introduction will require political and financial support at every level. Considerable work is still required to achieve a better understanding of the processes involved in the pathogenesis of severe and complicated malaria. Only then will it be possible to develop new and appropriate therapies that will be widely applicable.
Maitland
Kathryn
K
The Centre for Geographic Medicine Research, Coast, KEMRI, Kilifi, Kenya. Kmaitland@kilifi.mimcom.net
Makanga
Michael
M
Williams
Thomas N
TN
D000818:Animals; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000503:physiopathology; D010963:Plasmodium falciparum / Q000187:drug effects
D000962:Antimalarials