Historical Review: Problematic Malaria Prophylaxis with Quinine

Abstract

Abstract. Quinine, a bitter-tasting, short-acting alkaloid drug extracted from cinchona bark, was the first drug used widely for malaria chemoprophylaxis from the 19th century. Compliance was difficult to enforce even in organized groups such as the military, and its prophylaxis potential was often questioned. Severe adverse events such as blackwater fever occurred rarely, but its relationship to quinine remains uncertain. Quinine prophylaxis was often counterproductive from a public health viewpoint as it left large numbers of persons with suppressed infections producing gametocytes infective for mosquitoes. Quinine was supplied by the first global pharmaceutical cartel which discouraged competition resulting in a near monopoly of cinchona plantations on the island of Java which were closed to Allied use when the Japanese Imperial Army captured Indonesia in 1942. The problems with quinine as a chemoprophylactic drug illustrate the difficulties with medications used for prevention and the acute need for improved compounds.

Tafenoquine for travelers' malaria: evidence, rationale and recommendations

“…Suppressive chemoprophylaxis of malaria with blood schizontocides like quinine, atabrine, chloroquine, doxycycline, mefloquine and atovaquone–proguanil has successively dominated practice in travel medicine for over a century. 41 , 42 This strategy served the intended purpose of effectively preventing attacks by what had been considered the only intrinsically dangerous species, P. falciparum . The inadequacy of chemoprophylactic suppression alone against the delayed attacks of the relapsing malarias has long been understood and thoroughly demonstrated.…”

Anti-malarial activity of traditional Kampo medicine Coptis rhizome extract and its major active compounds

“…Furthermore, the use of herbal medicine for isolation of the natural product from herbal medicine has received increasing attention. It also represented a potential source of the conventional antimalarial drug [19,20], such as quinine which was isolated from Cinchona bark [21][22][23] and the use of Artemisia annua for isolation of artemisinin [24]. In Africa, herbal medicines are one of the most common traditional medicine and nearly 80% has been utilized as primary health care.…”

Antimalarial activity of traditional Kampo medicine Coptis Rhizome extract and its major active compounds

“…Interestingly, it persists as a crucial source of drug discovery [16]. Furthermore, isolation of the natural product from herbal medicine has received increasing attention and a potential source of the conventional antimalarial drug [20] represented by the isolation of quinine from Cinchona bark [21,22,23] and artemisinin from Artemisia annua [24]. In Africa, herbal medicines are one of the most common traditional medicine and nearly 80% has been utilized as primary health care.…”