Historical Review: Problematic Malaria Prophylaxis with Quinine.

Area of Science:

• Pharmacology
• Tropical Medicine
• Public Health

Background:

• Quinine, derived from cinchona bark, was historically the primary drug for malaria chemoprophylaxis.
• Its use dates back to the 19th century, facing challenges in consistent administration and efficacy verification.

Observation:

• Compliance with quinine prophylaxis was difficult, even in structured settings like the military.
• Concerns existed regarding its overall prophylactic effectiveness and potential for rare severe adverse events like blackwater fever.

Findings:

• Quinine prophylaxis could be counterproductive, leading to suppressed infections that still produced gametocytes, thus sustaining mosquito infectivity.
• A global pharmaceutical cartel controlled quinine supply, creating a monopoly and impacting availability, particularly during geopolitical events like WWII.

Implications:

• The challenges associated with quinine underscore the inherent difficulties in developing and implementing preventive medications.
• There is a clear and ongoing need for the development of improved chemoprophylactic compounds for infectious diseases like malaria.