Biology Reference
In-Depth Information
conduct large-scale field operations such as MDA (
A research agenda for
malaria eradication: drugs, 2011
). Skin patch or other simple drug-delivery
technology may offer another solution especially if one can develop forms
that can be used by non-medical personal and monitored to document
compliance. A suggested product profile is shown in
Table 6.3
about what
an idealized MDA might look like for malaria elimination.
Table 6.3
Proposed Product Profile for Mass Administration of a Drug to Stop Malaria
Transmission in a Defined Area
Parameter
Minimum Essential
Ideal
Efficacy
Sustained (2-4 weeks)
transmission blocking
within a defined area
after MDA
3 months transmission
blocking within a
defined area after MDA
Duration of action
*
2 weeks
3 months
Bioavailability / effect
of food
Little
None
Dosing regimen
Daily doses over < 2 weeks
Single dose
Safety
†
SAEs and AEs no worse
than chloroquine
No SAEs; minimal AEs
Safety in pregnancy
‡
Requires screening out of
pregnant women
Does not require any
screening for pregnancy
in community
Compatibility with
EPI vaccines
Serological responses not
significantly affected
Serological responses not
affected
Formulations
Scored tablets resistant to
humidity
Paediatric version
available; Sustained
release single tablet
resistant to humidity
Cost of treatment
circa
$1.00
≤ $4.00
Shelf life
≥2 years
6 years
Susceptibility to loss
of efficacy due to
acquired resistance
§
Very limited if any
Severely limited by
sporontocidal activity of
active compound
*Although shorter duration of activity may be possible in highly seasonal transmission areas by giving
MDA at nadir of transmission, pulse of drug into a community by MDA is meant to stop transmission
long enough to push area under excellent control into actual elimination of parasite.
†
Tolerance and safety are key issues in any MDA strategy. Safety in G6PD-deficient individuals must
be sufficient to not require G6PD screening (
Kuwahata et al., 2010
). Methylene blue appears to have
less haemolytic potential than primaquine (
Meissner et al., 2005
;
Coulibaly et al., 2009
).
‡
Uncertainty as to how 8-aminoquinoline would affect G6PD-deficient foetus within a
G6PD-normal mother may require urine pregnancy testing of women of child bearing age.
§
8-aminoquinoline likely to block transmission for substantial periods of time both in drug treated
individuals and in mosquitoes who feed on drug treated persons.
