Chloroquine works again, but scientists urge caution

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[Lilongwe] A study in Malawi suggests that chloroquine is once again effective against malaria, over a decade after it was withdrawn from use in the country due to parasite resistance to the drug.

The research team, whose work was published last week (9 November) in the New England Journal of Medicine, says the drug should not be re-introduced as a front-line treatment, but could be used as an intermittent therapy for pregnant women or in combination with other drugs.

Malawi was the first country in Africa to withdraw chloroquine from use 12 years ago as it no longer worked against most malaria cases.

The clinical trials involved 210 children with malaria in Blantyre, Malawi. They were treated with either chloroquine or a combination of sulfadoxine and pryrimethamine.

Treatment failure occurred in only one child among 105 participants assigned to receive chloroquine, whilst the other treatment failed in 71 of the participants.

Malcolm Molyneux, director of the Wellcome Trust Malaria project in Malawi told SciDev.Net that the research indicates that chloroquine should not be completely discounted as a malaria treatment, but should only be re-introduced with agreement from the whole continent.

However, Grace Malenga, director of the Malaria Alert Centre at the Malawi College of Medicine warned that despite the positive results, it is dangerous to start using the drug again on its own.

“It is important to combine chloroquine with other drugs because of growing resistance,” said Malenga, adding that research will continue into using chloroquine in combination with other anti-malarial drugs.

Storn Kabuluzi, manager of the National Malaria Control Programme in Malawi said: “We don’t [intend] to start using the drug now, but switch to Arteminisin-based combination treatment in line with World Health Organization recommendations.”

Arteminisin-based drugs are effective, work rapidly and have few adverse effects, and if combined with unrelated compounds they delay the emergence of resistance.

Malaria is still by far one of Africa’s largest obstacles to economic development, causing more than one million deaths each year.

Link to full article/paper in the New England Journal of Medicine

Reference: New England Journal of Medicine 355:1959 (2006)