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Originale del 25-5-04 su: The Cape Argus

University of Cape Town (UCT) researchers have found a more effective way of killing malaria parasites than quinine, offering new treatment hope to people with severe malaria in remote areas.

With about 3 000 people dying daily from malaria, most of them children, the new treatment promises far-reaching health implications, especially in sub-Saharan Africa where almost all (90 percent) of malaria cases occur.

The new study, by Dr Karen Barnes of UCT's department of pharmacology and colleagues in South Africa and Malawi, found that a simple suppository could save the lives of people with malaria while they travel to reach hospital treatment.

Called artesunate and given as a suppository, the drug will, according to Barnes, help address the fact that a large number of people with severe malaria are too ill to swallow malaria tablets, and so would need injections to keep them alive.

'This delay can cost them their lives, as severe malaria progresses rapidly'
But for those living in remote areas, the journey to a facility to get these injections could be hours, if not days away.

"This delay can cost them their lives, as severe malaria progresses rapidly," she said.

Artesunate is a derivative of the active ingredient artemisinin, found in the plant Artemesia annua (sweet wormwood), which has been used for more than a thousand years as a treatment for fever in China.

The results of Barnes's study, published in the latest edition of The Lancet, said "a single rectal dose of artesunate is associated with rapid reduction in parasite density in adults and children with moderately severe malaria, within the initial 24 hours of treatment".

Barnes said in the article that the option was a useful alternative way to start treatment in patients who couldn't swallow medication. Many patients with malaria may be vomiting severely, or, in the case of cerebral malaria, may be comatose.

'The WHO has submitted the product to the most rigorous authorities'
The suppository treatment was particularly important in cases where injections were unavailable.

UCT said in a statement that Barnes and her colleagues had compared their suppository treatment with the current standard of quinine injections, and found their option more effective in killing malaria parasites. The two treatments were however, clinically equivalent.

"The study also found rectal artesunate treatment to be safe and readily acceptable to patients and their families," the university said.

Barnes said her study was unusual because the World Health Organisation (WHO) had taken responsibility to develop the product, a reflection of the desperate public health need.

"The WHO has submitted the product to the most rigorous authorities, including the United States's Food and Drug Administration, so that once it's registered by these big authorities, it'll be much quicker and easier for African countries to make it available," she said.

The final components of the application are expected to be submitted soon, and Barnes said they hoped it would be registered for use by the end of the year.

The drug is being tested on 10 000 patients in Bangladesh, Ghana and Tanzania to determine whether it reduces the number of deaths from malaria if it is made widely available.

Next year they plan to test the drug on patients even more ill with malaria than the ones in Barnes's study, to determine its efficacy in different circumstances.

In South Africa, Barnes said, there were "very small" numbers of cases of malaria relative to the rest of Africa.

KwaZulu-Natal underwent a particularly severe malaria epidemic between 1996 and 2000 when the first-line treatment was changed to a new artemisinin-based combination drug called Coartem, and the insecticide DDT was reintroduced in a bid to stem it.

"The effect was massive. The number of cases of malaria there was reduced by more than 80 percent," she said.

Plans for dispensing the new suppository are envisaged to start at clinic level in Africa.

"If clinic use goes well, the next step would see these suppositories dispensed by community health workers, and if that goes well too, then we could look at home-level treatment.

"This appears to be a very safe and easy treatment method, especially compared with injectable treatment, considering the amount of training and time available to the lowest level of healthcare workers across this continent," Barnes said.