With malaria killing up to a million people yearly most of them children living in Africa, experts have disclosed that the use of antibiotics, administered regularly in combination with currently used malaria medicines, would form a valuable additional tool in fighting the disease,  reports Sade Oguntola.

Malaria infects an estimated three million people around the world each year and causes as many as one million deaths - most of them children living in Africa, where a child dies of the disease every 45 seconds.

So far, experimental vaccines offer only partial protection against malaria, which causes high fever, chills, body aches and at worst, brain complications leading to death.

But a team of researchers from Britain, Germany and Kenya has found that a combination of two widely available and inexpensive antibiotics given once a week at the height of malaria season, has the potential to protect people living in endemic areas and may even offer life-long protection the same way a vaccine would.

There is still no medicine that reliably protects people from infection and simultaneously promotes building up long-term immunity. In regions where malaria transmission is moderate to high, humans are repeatedly bitten by mosquitoes infected with the malaria parasite. If the body can survive the first infection, it can develop its own immune response.    

According to the experts, if the finding in laboratory mice holds true in humans, these two widely available and inexpensive antibiotics - clindamycin and azithromycin is hoped to generate protection for subsequent malaria reinfections. These are common antibiotics used against a range of bacterial infections.

They reasoned in a report on their findings published in the Science Translational Medicine journal that the antibiotics stimulate a strong protective immune response against the malaria parasite while it is in the liver of an infected individual, the symptomless first stage in the parasite’s life cycle.

The immune reaction causes changes in the cells of the malaria spores, thus making it impossible for parasitic spores to be released into the bloodstream to infect red blood cells, the second stage of the life-cycle that causes life-threatening malaria symptoms. The parasite then dies because it cannot infect the red blood cells it needs for sustenance.

The scientists studying how antibiotics attack a subunit of the malaria parasite called the apicoplast, which has some similarities with bacteria gave the mice a dose of one of the drugs at the same time as they inoculated them with malaria parasites. The parasites infected the animals’ livers, but none of the mice developed symptoms of malaria.

A month later, after all traces of the drugs were gone from the animals’ blood streams, the animals were still immune to the disease: They showed no symptoms after receiving a dose of parasites that gave control animals cerebral malaria—the most deadly form of the disease.

For now the researchers suggested that this might turn out as a traditional vaccination that would take advantage of mosquitoes spreading parasites naturally.

Medical experts assure that Azithromycin is safe in infants and pregnant women, the two most vulnerable groups to malaria. In fact, a combination of azithromycin and chloroquine (a common malaria drug), currently approved to treat pregnant women in areas at high risk of malaria, would be fairly easy to test in an initial human trial.  Already, azithromycin has been used in mass campaigns against trachoma without losing its potency

Dr. Ishola Gbenla, Medical director, Modupe Hospital, Oje, Ibadan, Oyo State, saying that an antibiotic was not used as a cure for malaria, disclosed that antibiotics really has no role in treatment of malaria unless there are some other underlying infections.

According to the medical expert, the common practice was to prescribe antibiotics and malaria medicines, especially in children with upper respiratory diseases and typhoid fever.

Dr. Olatunde Abdulazeez, Medical Director, Jarba Foundation, Offa, said in some instances antibiotics are prescribed alongside malaria medicines.

He explained that with increasing resistance to malaria medicines and the possibility of other underlying infections, antibiotics are sometimes prescribed.

He explained, “The point is you may use some malaria medicines and you feel well for some days only for the symptoms to reappear or complications of malaria. This is an indication of having a malaria resistant strain.”

He declared that in helping a patient  while treating the person for malaria, medicines are also going to help boost the person’s body immunity.

Meanwhile, an advantage of this approach is that it does not require the “technically and logistically challenging” production and delivery of weakened parasites to a population.

However, the researchers cautioned that the idea might not work in areas where malaria seasons are high risk but relatively short, and where those in danger could be sure to take the protective medicines before being infected. A fairly large dose of parasites seems to be required to prompt strong immunity.

It has been established that people living in areas where malaria is common develop natural immunity and several scientists have been trying to mimic this effect by creating a vaccine with whole parasites, either damaged or killed. Already small human trials have shown good results but developing such a vaccine won’t be cheap.

Current therapies for malaria are plagued by increasingly rapid drug resistance, which has become endemic in certain regions of the world.

According to the World Health Organization, the inappropriate use of antimalarial drugs during the past century, including poor management of use, deployment of drugs on a large scale and use as monotherapies, has contributed to the current situation of unacceptably high levels of resistance. This growing resistance to antimalarial medicines has spread very rapidly, undermining malaria control efforts.

To protect the current first line malaria medicines against losing effectiveness, the Federal Ministry of Health has directed that only malaria drugs containing an ingredient called artemesinin in combination with other approved molecules should be used. Artemisinin is extracted from a Chinese herb, which is gaining popularity among Kenyan farmers. Malaria drugs previously known as SP such as Fansider will only be used for parasite control in pregnant women.

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