Nature Medicine | Spoonful of Medicine

New malaria studies challenges us to think outside the net

baby_under_net_kenya_hamel_CDC.jpgWe’ve seen prophylactic use of medicines in the headlines, most recently with the November 2010 news that taking a preventative dose of the HIV drug Truvada cut the risk of infection by 44% among gay and bisexual men. Two studies published yesterday apply the idea of prophylactic drug use to malaria, and suggest that giving young children anti-malarial drugs might outweigh the risk of facing future resistant parasites in malaria-endemic countries.

One study, led by Diadier Diallo of the London School of Hygiene and Tropical Medicine, followed more than 3,000 children in Burkina Faso. It found that those treated with the antimalarial drugs sulphadoxine pyrimethamine and amodiaqune experienced at least 65% fewer malaria episodes than those protected by long-lasting insecticide-treated bed nets alone. The other trial, conducted in Mali by Alassane Dicko from the University of Bamako and his colleagues produced similar results. “Malaria control depends on a combination of strategies,” says Diallo.

Sulphadoxine pyrimethamine and amodiaqune are not the primary antimalarials in use, which makes some experts less worried that prophylactic administration of these particular medicines will result in the explosion of drug-resistant malaria parasites.

“We know there is resistance to both of the components of the drug but they’re still able to deliver this long lasting preventative effect,” says Patrick Kucher, a malaria expert at the US Centers for Disease Control and Prevention.

Christopher Plowe, who studies malaria at the University of Maryland School of Medicine, agrees that this strategy may outweigh the risks. Still, he adds that it’s important that health officials keep an eye out for resistant strains: “To me, if there is a clear evidence of a public health benefit, it may be well worth going from clinical trials to pilot programs with careful monitoring of resistance.”

Image from the CDC

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