The role of anti-malarial drugs in eliminating malaria

Nicholas J White

doi:10.1186/1475-2875-7-s1-s8

Abstract

Effective anti-malarial drug treatment reduces malaria transmission. This alone can reduce the incidence and prevalence of malaria, although the effects are greater in areas of low transmission where a greater proportion of the infectious reservoir is symptomatic and receives anti-malarial treatment. Effective treatment has greater effects on the transmission of falciparum malaria, where gametocytogenesis is delayed, compared with the other human malarias in which peak gametocytaemia and transmissibility coincides with peak asexual parasite densities. Mature Plasmodium falciparum gametocytes are more drug resistant and affected only by artemisinins and 8-aminoquinolines. The key operational question now is whether primaquine should be added to artemisinin combination treatments for the treatment of falciparum malaria to reduce further the transmissibility of the treated infection. Radical treatment with primaquine plays a key role in the eradication of vivax and ovale malaria. More evidence is needed on the safety of primaquine when administered without screening for G6PD deficiency to inform individual and mass treatment approaches in the context of malaria elimination programmes.

Highlights

Anti-malarial drugs play a central role in the control and ultimate elimination of malaria, but, in most circumstances, they cannot do the job alone
Biological considerations As human malaria is transmitted by sexual stages of the parasites, not asexual stages, infecting anopheline mosquito vectors, transmission depends upon the duration for which gametocytes are carried in the blood, the infectivity of this gametocytaemia to the local vectors, and the abundance and behaviour of the vectors [4]
Plasmodium falciparum differs from the other three human malarias in two important respects; first, gametocyte formation is delayed with respect to the peak production of asexual stages [1113], and, second, that mature gametocytes are resistant to most of the anti-malarial drugs, which affect asexual stages

Summary

Introduction

Anti-malarial drugs play a central role in the control and ultimate elimination of malaria, but, in most circumstances, they cannot do the job alone. Anti-malarials, if effective, reduce the transmission of malaria, but the relationship between efficacy and transmission reduction is not straightforward. Biological considerations As human malaria is transmitted by sexual stages of the parasites, not asexual stages, infecting anopheline mosquito vectors, transmission depends upon the duration for which gametocytes are carried in the blood, the infectivity of this gametocytaemia to the local vectors, and the abundance and behaviour of the vectors [4].

Results

Conclusion