Volume 31, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


To the Editor:

The communication “Quinine alone versus quinine plus pyrimethamine-sulfadoxine combination in the treatment of cerebral malaria” ( 1342–1343, 1981) requires clarification on several important issues.

Clearly the desperate human conditions in the early days of Sakaeo camp called for great resourcefulness and skill on the part of all health professionals. As the authors noted, quinine was the life-saving drug of choice for complicated infections. Recently published data from Thailand had shown that quinine retained a rapid schizonticidal effect against chloroquine-resistant (parasite clearance time 3–3.3 days). In other studies, the combination of quinine and pyrimethamine-sulfadoxide (Fansidar®) was more effective than quinine administered alone in radically curing uncomplicated falciparum infections. However, Fansidar acts relatively slowly as a blood schizonticide and did not significantly reduce the parasite clearance time as compared to quinine therapy alone. It therefore is questionable whether the inclusion of Fansidar as a life-saving drug in the treatment of cerebral malaria had substantial theoretical bases, particularly when conducted in such a relatively uncontrolled fashion as reported by Naparstek et al.


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