Antimalarial drugs: Mode of action and status of resistance

Malaria is a major global health problem, with an estimated 300 to 500 million clinical cases occurring annually. Malaria remains one of the leading causes of disease and death in the tropics, mainly of children under 5 years of age. The most prevalent and dangerous type of malaria is caused by Plasmodium falciparum. P. vivax is a common cause of malaria in Latin America, Asia, and Oceania, but not Africa. P. malariae and P. ovale are much less common. Antimalarials are used in three different ways: prophylaxis, treatment of falciparum malaria, and treatment of non-falciparum malaria. Prophylactic antimalarials are used almost exclusively by travelers from developed countries who are visiting malaria-endemic countries. The antimalarials in common use come from the following classes of compounds: the quinolines (chloroquine, quinine, mefloquine, amodiaquine, primaquine), the antifolates (pyrimethamine, proguanil and sulfadoxine), the artemisinin derivatives (artemisinin, artesunate, artemether, arteether) and hydroxynaphthaquinones (atovaquine).