Intended for healthcare professionals


Oral quinine for the treatment of uncomplicated malaria

BMJ 2009; 339 doi: (Published 21 July 2009) Cite this as: BMJ 2009;339:b2066
  1. Hugh Reyburn, senior lecturer1,
  2. George Mtove, research scientist2,
  3. Ilse Hendriksen, research fellow3,
  4. Lorenz von Seidlein, senior scientist4
  1. 1London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2National Institute for Medical Research, Amani Centre, Tanga, Tanzania
  3. 3Mahidol-Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
  4. 4Joint Malaria Programme, Bombo Hospital, Tanga, Tanzania
  1. Hugh.reyburn{at}

    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 …

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