Date of this Version
CLINICAL MICROBIOLOGY REVIEWS, July 2009, p. 508–534
The scope and depth of this review reflect the complexity of therapy for malaria in general and of Plasmodium vivax in particular. Even for malariologists steeped in an understanding of the treatment of acute, uncomplicated malaria caused by Plasmodium falciparum, P. vivax challenges. The tendency to fold the two species together into a single conceptual framework, and they indeed share some common ground, leads to errors in both strategic reasoning and practice with therapies. These two species are biologically and clinically distinct in fundamentally important ways. This review attempts to draw a distinction with P. vivax in the broad context of chemotherapies and resistance to them. This task carries the necessity of detail permitting a grasp of therapeutic strategies, the problem of resistance to those therapies, and an appreciation of the singular nature of these among human malarias. The review gathers and links seemingly disparate facets of biology, epidemiology, and clinical science of the infection along with key aspects of the pharmacology of the drugs arrayed against it. The aim is an improved likelihood of the effective application of science against these parasites, which are responsible for so much human suffering.