Drug-Resistant Malaria - libdoc.who.int - World Health Organization

OPENING ADDRESS / 11
is also here and ready to continue their assistance in the field
of malaria chemotherapy. This, in itself, is indicative of the
importance and gravity of the problems being encountered in so
many countries in this field. It is true that drug resistance 1S
not exclusively linked to malaria and that other diseases, mainly
communicable, have problems connnected with resistance of the
causative agents to drugs. Drug resistance is not only a problem
to present-day malariologists, since it had already been observed
in the past that infections, particularly those with Plasmodium
falciparum, did not respond to the same drug in the same manner,
in different geographical areas. Marchiafava was the first, with
Bignami, to note the difference in the clinical symptoms caused by
P. f alciparum in East Africa and in Italy. This was confirmed by
Robert Koch in the early part of this century. It was again
observed by workers at the Malaria Therapy Station in Horton, UK,
in 1920. More detailed studies carried out in the United States
during the Second World War confirmed previous observations and
also indicated that this problem could be resolved by adjusting
the doses and regimens of drugs existing at that time.
Since the initiation of malaria eradication programmes in
most countries affected by malaria, with the exception of Africa
south of the Sahara, the use of antimalarial drugs in malaria
control/eradication was advocated mainly for the depletion of the
parasite reservoir. Looking back at the late 1950s and 1960s, it
is difficult to escape the impression that the resistance of
P. f ale iparum to 4-aminoquino lines detec ted in South-East Asia and
South America was considered more as a problem of academic
interest rather than as an obstacle to the eradication of the
disease. However, the resurgence of the disease in the early
1970s, particularly in South-East Asia and parts of Central and
South America, coupled with the ever-increasing spread of
P.falciparum resistance to 4-aminoquinolinos and more recently, to
a combination of sulfadoxine/pyrimethamine, has become such an
important problem that many health administrators are wondering
how to continue with malaria control in areas where this problem
occurs.
Research on the development of antimalarial drugs has been
pursued for many years and, in the last 10 to 15 years, more than
250 000 compounds have been screened and tested but only a few
could be considered as suitable candidates. But, even though the
future does not seem very promising in this respect, there is no
place for pessimism. We must continue with our efforts and with
activities such as this meeting which has been organized to review
every possibility available in the utilization of the existing
antimalarial drugs and their combinations.
It 1S
scientists
resistance.
carried out
a pleasure to see the enthusiasm with which so many
have accepted to undertake the monitoring of drug
In this respect the number of susceptibi lity tests
in the last two years speaks for itself. However, the