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Gin & tonic – the first bittersweet antimalarial
22 May 2023
We must not leave children behind in our efforts to defeat malaria: no more bitter antimalarial pills!
During the 1700s, antimalarial properties of quinine were first unleashed. British soldiers stationed in India began drinking tonic water to prevent and combat the disease. However, quinine has a pronounced bitter taste; in the 1800s, gin was added to make the tonic more palatable. Later, lemon and lime were added to the mix, creating the classic Gin & Tonic cocktail. Nowadays, the amount of quinine in tonic water is minimal and more effective antimalarial drugs are used in clinical practice. However, the bitter taste of antimalarials still remains an undebatable challenge.
The World Malaria Day 2023 themed "Time to deliver zero malaria: Invest, Innovate, Implement," had a particular emphasis on the third "I" – implement with the focus to reach those most at risk of malaria to make progress towards eradicating it altogether. The COVID-19 Pandemic has caused a setback: the 2 peak years of disruptions resulted in approximately 13 million additional malaria cases and 63,000 more malaria-related deaths globally, with the WHO African Region carrying disproportionately the burden i.e. 95% of all cases and 96% of all deaths (2021). Alarmingly, children under 5 years account for approximately 80% of all malaria deaths in this region.
Prof Tuleu and Dr Ranmal
Undoubtedly, children remain the most at risk, as they are uncompromising when it comes to taking unpalatable treatments, which can jeopardize therapeutic outcomes. With the aim to develop palatable, swallowable, stable (and Gin free!) paediatric antimalarial formulations, Professor Catherine Tuleu and Dr Sejal Ranmal at UCL School of Pharmacy have been collaborating on two important projects:
- The DPP (Developing Paediatric Primaquine) consortium aims to develop and deploy quality-assured, child-friendly primaquine across a range of doses in optimised regimens for transmission blocking and radical cure for malaria. This €3.5m project is part of The European & Developing Countries Clinical Trials Partnership (EDCTP2) programme supported by the European Union (RIA2019PD-2893).
- The MMASQ (MicroCoat™ technology for Taste Masked ArteSunate/amodiaQuine malaria combination therapy) project, funded by a $1.9m UnitaidExplore grant, aims to develop a fixed dose combination of artesunate and amodiaquine as cost effective taste masked micropellets using the MicroCoatTM technology developed by Fluid Pharma.
As Professor Tuleu remarked ’these projects leverage our Sensory PharmaceuticsTM expertise, providing tools and strategies to optimise taste masking efficiency and design medicines easier to give to very sick children, to ultimately improve outcomes for vulnerable children with malaria around the world’.
Further information
Unitaid - Paediatric drug formulations for poverty-related diseases
Unitaid - Innovations in paediatric medicines delivery awarded UnitaidExplore funding