Amodiaquine and malaria prophylaxis

In 1985 the WHO and the United States Centers for Disease Control recommended that amodiaquine (400 mg weekly) could be used as a first-line malaria prophylactic in areas of the world with chloroquine resistance. Recently both the WHO and the CDC have withdrawn this recommendation. In this article, Tim Peto and Charles Gilks discuss the reasons behind the original recommendation and the events that led to the sudden change.     

Current approaches to malaria chemotherapy and prophylaxis

Malaria continues to be one of the most serious and widespread parasitic diseases, still occurring in over 100 countries despite concentrated efforts to eradicate it from many regions. Sixty-one countries now report their malaria cases to the WHO, and the latest analysis of these figures' shows little improvement in the overall problem during the last 15 years. Some countries, notably India and China, continue to report downward trends, but the problem continues to deteriorate in rural areas where intense economic development is taking place, particularly in Asia and the Americas. In 1984, 5.3 million cases of malaria were reported to the WHO. This is believed to represent but a small fraction of the total number because, for example, 38 of the tropical African countries do not report their malaria cases. Estimates based on the degree of malaria endemicity suggest a total incidence o f around 100 million cases annually. Chloroquine-resistant falciporum malaria has been confirmed in more than 40 countries, often showing cross-resistance to other drugs, and attempts to combat resistance using combination drugs have led to disturbing reports of side-effects as well as multidrug resistance. Vector control is also impaired in many areas due to insecticide resistance. Faced with these problems, we asked Dr Walther Wernsdorfer, head of the WHO Malaria Action Programme, what is the current WHO philosophy of malaria chemotherapy and prophylaxis?     

Severity of imported falciparum malaria: effect of taking antimalarial prophylaxis.

OBJECTIVE--To investigate the effects of antimalarial chemoprophylaxis and other variables on the severity of falciparum malaria. DESIGN--Review of consecutive malaria cases between 1987 and 1991. SETTING--The Hospital for Tropical Diseases, London. SUBJECTS--250 consecutive cases of mild and 51 consecutive cases of severe falciparum malaria. RESULTS--Prophylaxis was taken in 52.4% (131/250) of the cases of mild malaria and 21.6% (11/51) of cases of severe malaria. Severe malaria was more common in white patients than in those of African origin and was also seen more commonly in people returning from central, southern, and east Africa than in those returning from west Africa. Patients with severe malaria presented sooner than patients with mild malaria. CONCLUSIONS--Prior chemoprophylaxis led to a reduction in the severity of falciparum malaria. Ethnic origin, time to presentation, and sex were also associated with the severity of malaria.     

Urgent problems in the organization of malaria prophylaxis

The causes contributing to the appearance of local cases of malaria and to the isolated foci of this disease in some of the southern republics of the USSR are analyzed. Modern means for the control of this infection are considered. The complex of measures necessary for the final liquidation of malaria in the USSR, the CMEA countries and the developing countries of socialist orientation are outlined.