A Very Sweet Drug

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For more than 400 years, the world has largely relied on quinine to combat malaria, especially the most severe cases, which kill up to 2.7 million people a year. But a study by the medical-research charity Wellcome Trust published in the Lancet last Friday showed that an injectable version of the drug artesunate—one of a range of medicines derived from sweet wormwood, a traditional Chinese herb—can reduce the chances of death from severe malaria by 35% compared to quinine. The results were so striking that the study is likely to alter the World Health Organization's (WHO) recommendations for treatment of severe malaria. "This is quite significant," says Dr. Peter Olumese, a malaria-drug-policy expert at the WHO. "This drug is a good product."

Artesunate is easier to use than quinine and has fewer side effects. (Quinine can be toxic if incorrectly administered.) The drug's main advantage is its ability to prevent malaria-infected red blood cells from sticking together in a process called sequestration. When this occurs in the brain it can cause cerebral malaria, one of the most deadly forms of the disease. "It's just like Bangkok traffic in the mornings," says professor Nick White of Mahidol University in Bangkok, who led the study. "[Artesunate] reduces the traffic jam, which is what kills people." The study's results still need to be replicated in African children, by far the worst victims of the disease; it's possible they will react differently than the subjects in the Wellcome Trust trials, which took place in India, Bangladesh, Indonesia and Burma. In addition, the Chinese companies that manufacture the injectable version of the drug haven't yet received full approval from the WHO. When they do, the world will have a formidable weapon against an ages-old scourge.