Back in 1993, Malawi was the first country in Africa to abandon chloroquine as a treatment for malaria. It had stopped working because of widespread chloroquine resistance and was replaced by sulfadoxine-pyrimethamine. But after an absence of 12 years, the parasite sensitive to chloroquine seems to be back. Encouraged by a decline in the genetic marker for resistance among falciparum malarial parasites, researchers recruited 210 infected children for a clinical trial. The old drug cured 99% (95% CI 93% to 100%) of those who took it, compared with a success rate of only 21% (13% to 30%) among those who took sulfadoxine-pyrimethamine. Chloroquine cleared the parasite in a mean of 2.6 (SD 2.5 to 2.8) days.
The return of chloroquine would be good news for children throughout sub-Saharan Africa, where falciparum malaria continues to be a leading killer. Chloroquine is safe, cheap, fast acting, and long lasting. But the authors and a linked commentary (pp 1956-7) agree that bringing it back now would be a mistake. “Malawi is surrounded by a sea of chloroquine resistance” which would soon break through its borders if choloroquine became widely available again, says the commentary. Resistance must be eliminated throughout the region first, a strategy that depends entirely on rich countries bringing down the cost of effective artemisinin-based combination treatments to less than 10 US cents a day. We can afford it, and should do it now.
References
- N Engl J Med 2006;355:1959-6617093247 [Google Scholar]