690 BOOK REVIEWS

illness, when to send patients to hospital and how to give advice to prevent illness. The lessons rely entirely on written or drawn posters, role plays, demonstra- tions, discussions and examination of patients. Clear precise instructions on the materials needed are given before starting each lesson. During and after each les- son, simple and practical guidelines enable the teacher to achieve maximum student participation and the stu- dents to practise what they have learned. Part 3 con- tains a number of appendices including reference charts, blow-by-blow accounts of how to practise or in- terpret the procedures described in the lessons and de- tails of health problems only common in some areas. The final 2 appendices comprise a checklist to help the trainer observe and record the students’ progress in the weeks following each lesson and a list of medicines with dosage and uses.

No manual can cover all illness or health care pro- blems. Birth and neonatal problems are omitted, prob- ably deliberately. In the lesson on tuberculosis, mention should have been made about the detection of tuberculous meningitis and miliary tuberculosis and, in its prevention, about contact tracing and breastfeeding. Whooping cough and tetanus are not included. The de- tection, assessment and management of disabilities, particularly deafness, are not covered. The authors en- courage comments on the teaching methods employed in this manual. They invite contributions on other methods tried by the users who I have no doubt will find the book an extremely valuable asset in their teach- ing and learning practice. A glossary, list of useful re- sources and references and an index complete the text.

The book is presumably available at minimal cost and I would recommend it wholeheartedly to all pri- mary health care trainers and workers.

Inverlussa Bridgend Callander Perthshire FK17 8AG, UK

Paget Stanfield

Drug Interactions in Infectious Diseases. S. C. Piscitelli & K. A. Rodvold (editors). Totowa, NJ: Humana Press, 2001. xii + 363~~. Price US$ 99.50. ISBN o-896-03750-9.

Drug interactions most commonly reported are those between 2 drugs, yet today’s polypharmacy means that the opportunity for drug-drug interactions is almost endless. Moreover, drugs may interact with food, bev- erages, alternative medicines and environmental chemi- cals. Disease states may alter the magnitude and duration of the pharmacological response. Interactions among drugs may arise through alterations in drug ab- sorption and disposition, i.e., pharmacokinetics, or by direct competition at sites of action or indirectly through altered physiological mechanisms, i.e., phar- macodynamics. This collection of articles examines a substantial number of drug interactions, highlights their medical importance and suggests ways in which they might be avoided.

Much of this book relates to HIV disease. This is not unreasonable when one considers the multitude of drug combinations used, not only against the virus but also in the management of opportunistic infections. How- ever, the relatively small amount of information on the potential for drug interactions in parasitic disease may dismay the tropical physician. I would refer them to the recent article by Giao, I’. T. & de Vries, P. J. (2001: Clinical Pharmacokinetics, 40, 343-373) whose exten- sive literature survey suggests the authors of this vo- lume would find little difficultv in acquiring sufficient information in this area for an additional chapter. How- ever, that point aside I found the information contained in this volume invaluable.

The book opens with an introductory chapter that overviews the type and significance of drug inter- actions, and a second chapter that discusses putative mechanisms. The following articles focus on HIV (2 chapters), tuberculosis, a variety of antibiotics and anti- fungal agents. Drug-food interactions are reviewed (although there is no reference to the huge drug-food interactions that occur with halofantrine or benzimida- zole anthelmintics), as are the effects of drugs on reg- ulation of expression of drug metabolizing enzymes and cytokine activity. Finally there are chapters dealing with the circumvention of drug interactions and, in my view most important of all, how to design studies that inves- tigate the magnitude of drug interactions in vivo.

Reading this volume indicates that there are a vast number of examples of drug interactions of undoubted clinical significance. Where it is understood, the me- chanism is detailed and approaches to alternative ther- apy are described. Also highlighted are the benefits of multiple therapy where drug-drug interactions are har- nessed to the advantage of the physician. The ritona- vir-saquinavir interaction is given particular emphasis. The case reports contained within most of the chapters are very useful. I would recommend this book to any- one involved in the management of infectious disease. While I accept that the subject is moving so quickly that keeping abreast of the literature is difficult, this volume is as comprehensive as anything currently available.

Geoffrey Edwards Department of Pharmacology and Therapeutics The University of Liverpool and Liverpool School of Tropical Medicine, Liverpool, UK

Antimalarial Chemotherapy: Mechanisms of Ac- tion, Resistance, and New Directions in Drug Discovery. P. J. Rosenthal (editor). Totowa, NJ: Humana Press, 2001. xiS396pp. Price USsb135.00. ISBN O-89603-670-7.

The drug therapy of malaria is both a rapidly evol- ving field and one with a long history. Central to the history of pharmaco-therapeutics, the evolution of anti- malarial research and treatment is scientifically interest- ing and full of excellent teaching examples. A monograph on the subject does not have to struggle for material and, in concept at least, the layout of a volume does not pose too many problems for a skilful editor. That is not to say that the compilation of expert know- ledge in readable review essay form is easy for either contributor or editor and this volume shows evidence of hard mental graft by all involved.

The editor, Philip Rosenthal, has assembled a broad range of malaria research talents to cover the monogra- ph’s themes from the history of antimalarial drugs and early usage (interestingly reviewed by Meshnick and Dobson), through reviews of drug action and resistance mechanisms to overviews of the prospects for new com- pounds. The role of genomic and post-genomic re- search in generating new targets based on our rapidly growing understanding of the parasite’s ‘metabalome’ is also covered in some depth. There is in fact a great deal of interesting malaria biology within this volume and, although the central theme is chemotherapy, drug discovery and development are so central to the scienti- fic history of malaria that this volume has interesting things to say about most aspects of malariology from ague to zygote.

The referencing of all the 20 chapters is very exten- sive and although there is some inevitable overlap, par- ticularly in the chapters on the quinolines, this is a well- planned and reasonably well-illustrated text. All the chapters can be profitably read by advanced students and the volume as a whole is a valuable resource for professional malariologists. It contains some material with insights of a depth that cannot readily be found in