A comparison of artesunate alone with combined artesunate and quinine in the parenteral treatment of acute falciparum malaria

In some areas clinicians have combined parenteral artesunate and quinine in the belief that the 2 drugs would be additive or synergistic in severe mal aria. A randomized comparison of the effectiveness of intravenous (iv) arte sunate versus iv artesunate and iv quinine together on parasite clearance w as conducted in 1998/99 amongst 69 patients with uncomplicated and severe P lasmodium falciparum malaria in western Thailand. The parasite clearance ti me did not differ significantly between the 2 treatment groups (P = 0.12), but adverse events were significantly more frequent in the artesunate plus quinine group (P = 0.05). Quinine did not have a significant antipyretic ef fect and artesunate did not affect the electrocardiographic QTc interval. T here is no benefit evident from combining parenteral administration of thes e 2 antimalarial drugs in the acute phase of treatment.