Several African countries that have adopted
artemisinin-based combination
therapy (ACT) as first-line treatment of uncomplicated
Plasmodium falciparum malaria also use
quinine monotherapy as second-line
therapy. This policy goes against WHO recommendations for combination
therapy and could be considered an inappropriate public health policy. Adherence to a 7-day
quinine treatment schedule is likely to be poor and may increase the risk of selecting resistant parasites. Furthermore, because
quinine has limited post-treatment prophylaxis, it will not prevent, in areas of intense transmission, recurrent
malaria infections, which can lead to additional morbidity, including anaemia. Therefore, ACTs and not
quinine should be used as second-line treatment, because these are well tolerated, highly efficacious, and have the advantage of reducing gametocyte carriage and consequently
malaria transmissibility, particularly in areas of less intense transmission.