Ammunition against malaria
==========================

* Kevin Kain

We thank Russell MacDonald for his interest in our paper.1 As he points out, artemisinin derivatives are potent antimalarials that result in faster parasite and fever clearance times than any other class of antimalarials. The use of artemisinin-based suppositories represents a breakthrough in the management of severe and complicated malaria in medically underserviced areas of the developing world.

Unfortunately, unlike standard treatments such as parenteral quinine (currently the treatment of choice for severe malaria in Canada), artemisinin-based drugs have not been shown to decrease the mortality associated with severe malaria.2,3 Furthermore, most of the compounds currently in use have not gone through the formal safety and toxicity testing generally required by drug regulatory authorities in order for them to be licensed for use in developed countries. In addition, until recently these drugs were not generally produced using good manufacturing practices. However, a number of these derivatives are now made using good manufacturing practices and I posed MacDonald's question regarding their availability to the Health Protection Branch. Although there was some interest, they indicated that at present there are no plans to make these agents available in Canada.

## References

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    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjQvNS82NTQiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY1LzUvNTI5LjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Tran TH, Day NP, Nguyen HP, Nguyen TH, Tran TH, Pham PL, et al. A controlled trial of artemether or quinine in Vietnamese adults with severe falciparum malaria. N Engl J Med 1996; 335(2):76-83.
    
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3.  3. Van Hensbroek MB, Onyiorah E, Jaffar S, Schneider G, Palmer A, Frenkel J, Enwere G, et al. A trial of artemether or quinine in children with cerebral malaria. N Engl J Med 1996;335(2): 69-75.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1056/NEJM199607113350201&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=8649492&link_type=MED&atom=%2Fcmaj%2F165%2F5%2F529.1.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=A1996UW35300001&link_type=ISI)