Resisting resistance: dealing'with the irrepressible problem of malaria

摘要

Malaria is a worsening problem in the developing world. Snow and colleagues argue that there were 515 (range 300-660) million episodes of clinical Plasmodium falci-parum malaria in 2002. These figures are up to 50% higher than those reported by the World Health Organization (WHO) and 200% higher for areas outside Africa . The absence of an effective vaccine means that^we continue to rely on drugs to manage a disease that has arguably been overshadowed by HIV and tuberculosis. Our failure to combat this surge in malaria cases can substantially be attributed to a frightening increase in multiple drug resistance. Chloroquine resistance is now common in every region where P. falciparum occurs . Replacement of chloroquine with sulfadoxine-pyrimethamine provided a temporary respite, until this combination succumbed in South-eastAsia, South America and, most recently, Africa. Clinical failure of mefloquine and atovaquone was reported soon after their introduction