Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria
Dear Cecil: Tonic water contains quinine, because (I gather) quinine was the " tonic" against malaria in Britain's colony days. So is the dose in. It too is rooted global relationships that stretch even farther than gin. A key component of tonic water is quinine, an anti-malarial alkaloid from. World Malaria Day, is celebrated on April 25th, a crucial opportunity to reflect on lovers, drinking tonic water will not protect you from contracting malaria. resistance to artemisinin, an important component of anti-malaria.
Gin And Tonic For Malaria Prevention
Gin consumption exploded in England by the first half of the eighteenth century. London became the capital not only of a growing empire, but also the drinking of gin. The British Parliament responded to the craze by enacting a series of laws starting in the s that sought to curb the consumption of gin.
Historians such as Jessica Warner have compared such policies to the war on drugs in more recent times. At first, British lawmakers imposed a stiff tax on gin, but this policy led to a flood of illegally-distilled gin. Riots against the law erupted in Bythe government changed their strategy to favour a policy that increased the operating costs of gin shops.
The craze waned, although scholars argue that consumption declined because of rising grain prices, not government action. Nonetheless, gin remained a popular spirit in England. It too is rooted global relationships that stretch even farther than gin. A key component of tonic water is quinine, an anti-malarial alkaloid from the bark of the cinchona tree.
Europeans first realized the value of the plant in fighting malaria during the seventeenth century, after the Spanish had conquered parts of South America. Two popular accounts explain the development. In one, the Countess of Chinchon, wife of the Spanish Viceroy of Peru, brought the bark to Spain during the s after it had cured her of malaria in South America.
The advent of ACT has provided important new therapeutic options for the management of uncomplicated malaria in regions with high prevalence of multi-drug resistant malaria. A few available trials have shown superiority of ACT over quinine in the management of uncomplicated malaria [ 324546 ]. Considering the extensive available data, quinine should not be used to treat uncomplicated malaria when ACT is available [ 2745 ].
ACT has the advantages of simplicity of dosing, which promotes adherence to therapy when compared with the seven-day treatment courses of quinine [ 3245 ], better tolerance and decreased risks of serious toxicity.
Gin and Tonic: A Short History of a Stiff Drink
Nevertheless, despite their scale up in Africa, the cost and availability of ACT in the public sector remains a major challenge. The sustainability of ACT supplies in resource limited settings therefore presents a huge problem, with stock-outs consistently occurring in health facilities [ 48 ]. Quinine, on the other hand, is a relatively cheap drug and often the only available option, rendering its rapid withdrawal for uncomplicated malaria cases risky.
The best approach in these settings would be to proactively identify solutions to ACT stock-outs and maintain quinine as a fall-back drug only in case of ACT stock-outs. Additionally, improving quinine treatment outcomes by combining it with antibiotics, such as tetracycline or clindamycin [ 49 - 51 ], could be investigated and promoted.
More recently, combinations of quinine and newer antibiotics with shorter treatment regimens that would improve adherence to therapy as well as minimize related adverse events have been evaluated. One such combination is that with azithromycin which is of particular interest, as the drugs act synergistically [ 52 ].
These drug combinations will need further evaluation to confirm these findings and may offer a solution to the compliance problems associated with seven-day courses of quinine.
Quinine for malaria in pregnancy Malaria in pregnancy causes several adverse outcomes that include maternal anaemia, intrauterine growth retardation, low birth weight, preterm deliveries and abortion.
Prevention and treatment of malaria in pregnancy is, therefore, critical to avoid these adverse outcomes.
Currently the WHO recommends the use of quinine plus clindamycin for treating malaria in the first trimester of pregnancy, as the safety of artemisinin compounds during this period is not yet established [ 23 ]. As most clinical trials exclude women in their first trimester of pregnancy, information on the efficacy and safety of anti-malarial drugs during this period is extremely limited.
Evidence for the safety of quinine in pregnancy is mostly historical and there are few clinical trials published [ 5053 ]. Clindamycin on the other hand has a good safety record in pregnancy [ 54 ] and its pharmacokinetic properties are usually unchanged by pregnancy[ 55 ]. The combination of quinine and clindamycin has proven highly efficacious against multidrug-resistant strains of P.
The only concern with this combination is that it is usually not affordable for most resource limited settings. For the second and third trimester of pregnancy, quinine monotherapy seems to have unacceptably low efficacy in areas with multidrug resistant malaria when compared to ACT.
Studies in these regions have shown that ACT performs better than oral quinine in terms of parasite clearance and fever clearance. Two studies in Thailand [ 5657 ] reported fewer treatment failures at day 63 with artesunate plus atovaquone-proguanil and artesunate plus mefloquine, when compared with quinine. The occurrence of adverse events experienced by the pregnant women was similar in all groups, although tinnitus was more frequent in the quinine group.
The Spanish were aware of the medicinal properties of cinchona bark by the s or earlier: It was first used to treat malaria in Rome in During the 17th century, malaria was endemic to the swamps and marshes surrounding the city of Rome.
Malaria was responsible for the deaths of several popesmany cardinals and countless common Roman citizens. Most of the priests trained in Rome had seen malaria victims and were familiar with the shivering brought on by the febrile phase of the disease. The Jesuit brother Agostino Salumbrino — an apothecary by training who lived in Limaobserved the Quechua using the bark of the cinchona tree for that purpose. While its effect in treating malaria and malaria-induced shivering was unrelated to its effect in controlling shivering from rigorsit was a successful medicine against malaria.
At the first opportunity, Salumbrino sent a small quantity to Rome for testing as a malaria treatment. Prior tothe bark was first dried, ground to a fine powder, and then mixed into a liquid commonly wine which was then drunk.
Did you know that malaria spawned the gin and tonic?
Large-scale use of quinine as a malaria prophylaxis started around In Paul Briquet published a brief history and discussion of the literature on "quinquina". Quinine had been said to be the prime reason Africa ceased to be known as the "white man's grave".
A historian has stated, "it was quinine's efficacy that gave colonists fresh opportunities to swarm into the Gold CoastNigeria and other parts of west Africa". The Dutch government persisted in its attempts to smuggle the seeds, and in the late 19th century the Dutch grew the plants in Indonesian plantations.
Soon they became the main suppliers of the plant, and in they set up the Kina Bureau, a cartel of cinchona producers charged with controlling price and production. The US had obtained four million cinchona seeds from the Philippines and began operating cinchona plantations in Costa Rica. Such supplies came too late.