Proguanil-resistant falciparum malaria in Malaya.
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A 22-year-old Japanese man noticed pyrexia and diarrhea after travel to Guinea. Notable physical findings included hepatosplenomegaly. Treatment with oral quinine and minocycline was started after definitive diagnosis of falciparum malaria by blood smear. Initially, parasitemia and body temperature decreased but by the third night of therapy his temperature increased to 40 degrees C with a slight increase of parasite count. When quinine treatment was changed to atovaquone/proguanil, his temperature dropped immediately and complete plasmodial elimination was confirmed on microscopic examination. Subsequent recrudescence of the disease was not observed. It was concluded that the antimalarial treatment with atovaquone/proguanil might become invaluable in Japan.
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A complexation phenomenon between certain antimalarials (as donors) and chloranilic acid (as an acceptor) has been studied using thin-layer-chromatography (TLC). The antimalarials were subjected to charge--transfer complexation using chloranilic acid as the pi-acceptor. This technique was used for the qualitative detection of the drugs. Drug-spotted TLC plates, when developed in suitable solvent systems and sprayed with the pi-acceptor gave a spontaneous purple colour. The Rr values of the three drugs were found to be constant and specific for each drug sample in a particular solvent system.
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Prophylaxis for short-term travel in malaria-endemic areas can be difficult for two reasons. The first is that currently available antimalarial drugs are becoming less effective because of the ability of the parasite to adapt to drug pressure. The second involves poor compliance with chemoprophylactic regimens due to the highly restrictive conditions of administration and adverse drug side-effects, especially in "healthy" subjects. The combination of atovaquone/proguanil (Malarone) could provide an answer to both these problems since it is not only effective on multiresistant strains of Plasmodium falciparum but also simplifies the conditions of administration and shows good tolerance in adults and children.