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Quinine monotherapy for treating uncomplicated malaria in the era of artemisinin-based combination therapy: an appropriate public health policy?

Abstract
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.
AuthorsAdoke Yeka, Jane Achan, Umberto D'Alessandro, Ambrose O Talisuna
JournalThe Lancet. Infectious diseases (Lancet Infect Dis) Vol. 9 Issue 7 Pg. 448-52 (Jul 2009) ISSN: 1474-4457 [Electronic] United States
PMID19555904 (Publication Type: Journal Article, Review)
Chemical References
  • Antimalarials
  • Artemisinins
  • artemisinin
  • Quinine
Topics
  • Africa
  • Animals
  • Antimalarials (therapeutic use)
  • Artemisinins (therapeutic use)
  • Drug Resistance
  • Drug Therapy, Combination
  • Health Policy
  • Humans
  • Malaria, Falciparum (drug therapy)
  • Plasmodium falciparum (drug effects)
  • Quinine (therapeutic use)

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