Oral quinine for the treatment of uncomplicated malaria

doi:10.1136/bmj.b2066

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Hugh Reyburn, senior lecturer1,
George Mtove, research scientist2,
Ilse Hendriksen, research fellow3,
Lorenz von Seidlein, senior scientist4

¹London School of Hygiene and Tropical Medicine, London WC1E 7HT
²National Institute for Medical Research, Amani Centre, Tanga, Tanzania
³Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
⁴Joint Malaria Programme, Bombo Hospital, Tanga, Tanzania

Hugh.reyburn{at}lshtm.ac.uk

Is ineffective in outpatients and should be used only in rare cases

Artemisinin combination therapy is the first line treatment for uncomplicated malaria in nearly all malaria endemic countries in sub-Saharan Africa. This treatment is relatively expensive, but it kills parasites faster than any other method and has few adverse effects.1 The combination artemether-lumefantrine (Coartem) is co-formulated, can be taken in a convenient schedule over three days, and is popular with patients and healthcare providers.2 The linked study by Achan and coworkers (doi:10.1136/bmj.b2763) confirms the excellent cure rate (all patients were cured after adjusting for reinfection) of this drug in children with uncomplicated malaria in Uganda.3

However, oral quinine is often used to treat uncomplicated malaria either because artemisinin combinations are not available,4 or on the assumption that it must be effective because it is still the drug of choice for severe malaria in African children (although it is now known to be inferior to artesunate in Asian adults …