The contribution of clinical pharmacology to antimalarial drug discovery and development

Unlike human immunodeficiency virus (HIV) disease or tuberculosis, both of which are also major threats to public health throughout the tropics, uncomplicated falciparum malaria is relatively cheaply and rapidly cured, usually in Outpatients. However, in common with both HIV and TB (but to varying degrees), control of malaria is threatened by inadequate resources and drug resistance. Worldwide, it is Africa that carries the greatest burden of falciparum malaria mortality and morbidity; by no coincidence, it is also Africa that is most resource-limited. The drugs for severe disease (quinine and the artemisinins) are largely unaffected by resistance so far, but the 'first-line' drugs, mostly used by outpatients (mainly chloroquine and sulfadoxine-pyrimethamine) are a major cause for concern. Although effective drugs are available, they are largely too expensive for routine use. The present article reviews the ways in which clinical pharmacology has contributed to the identification of new drugs and strategies for malaria.