Winstanley Peter, Ward Stephen
Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool L69 3GE, UK.
Adv Parasitol. 2006;61:47-76. doi: 10.1016/S0065-308X(05)61002-0.
Most malaria control strategies today depend on safe and effective drugs, as they have done for decades. But sensitivity to chloroquine, hitherto the workhorse of malaria chemotherapy, has rapidly declined throughout the tropics since the 1980s, and this drug is now useless in many high-transmission areas. New options for resource-constrained governments are few, and there is growing evidence that the burden from malaria has been increasing, as has malaria mortality in Africa. In this chapter, we have tried to outline the main pharmacological properties of current drugs, and their therapeutic uses and limitations. We have summarised the ways in which these drugs are employed, both in the formal health sector and in self-medication. We have briefly touched on the limitations of current drug development, but have tried to pick out a few promising drugs that are under development. Given that Plasmodium falciparum is the organism that kills, and that has developed multi-drug resistance, we have tended to focus upon it. Similarly, given that around 90% of global mortality from malaria occurs in Africa, there is the tendency to dwell on this continent. We give no apology for placing our emphasis upon the use of antimalarial drugs in endemic populations rather than their use for prophylaxis in travellers.
如今，大多数疟疾控制策略仍像过去几十年一样依赖于安全有效的药物。但自20世纪80年代以来，疟疾化疗的主力军氯喹在整个热带地区的敏感性迅速下降，如今在许多高传播地区这种药物已毫无用处。资源有限的政府可选择的新药很少，而且越来越多的证据表明，疟疾负担一直在增加，非洲的疟疾死亡率也是如此。在本章中，我们试图概述现有药物的主要药理学特性、它们的治疗用途及局限性。我们总结了这些药物在正规卫生部门和自我药疗中的使用方式。我们简要提及了当前药物研发的局限性，但也试图挑选出一些正在研发的有前景的药物。鉴于恶性疟原虫是致死病原体且已产生多重耐药性，我们倾向于将重点放在它身上。同样，鉴于全球约90%的疟疾死亡发生在非洲，我们往往会详述这个大陆的情况。我们强调在疟疾流行地区使用抗疟药物而非用于旅行者预防用药，对此并不觉得需要致歉。
