Recent developments in the management of malaria.

The last decade has seen in increase in our understanding of the pathophysiology of severe malaria in both adults and children. However, this increased knowledge has yet to be matched by progress in the clinical management of this medical emergency. In the last few years a wide variety of measures have been advocated to lessen the mortality due to severe malaria, but none have shown a significant benefit in terms of mortality or morbidity. In this review we concentrate on aspects of the pathophysiology of malaria which are amenable to intervention at present or in the near future. In the field of uncomplicated malaria problems remain mostly related to the continued spread of drug-resistance and the limited array of available drugs. Outlined are a number of important advances in antimalarial pharmacology and parasite biology that may lead to future improvement in the care of patients with malaria.