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Combined Intravenous Treatment with Artesunate and Quinine for Severe Malaria in Italy

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  • Clinica Malattie Infettive, Dipartimento Area Critica Medico-Chirurgica, Università degli Studi di Firenze, Firenze, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy; Istituto Malattie Infettive e Tropicali, Università di Brescia, Brescia, Italy; Dipartimento di Pediatria, Università di Firenze, Firenze, Italy; UO Malattie Infettive, Spedali Riuniti Livorno, Livorno, Italy

Severe imported malaria is an important problem in European countries, where approximately 8,000 cases of Plasmodium falciparum malaria are reported each year. Although the World Health Organization recommends intravenous artesunate (IVA) as the treatment of choice for severe malaria in areas of low transmission, it is rarely used in Europe, because it is not yet available as a drug manufactured under Good Manufacturing Practices. We report a series of eight imported severe falciparum malaria cases treated with IVA combined with intravenous quinine (IVQ). This combined therapy was found to be efficacious, safe, and well-tolerated. The only observed death occurred in a young man who presented 10 days after the onset of symptoms. IVA plus IVQ treatment seems to be an acceptable approach, because the legal risks in using an unlicensed drug for treating a severe malaria case denies the patient the possibility of being treated with the most effective regimen.

Author Notes

*Address correspondence to Alessandro Bartoloni, Clinica Malattie Infettive, Università di Firenze, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. E mail: bartoloni@unifi.it

Authors' addresses: Alessandro Bartoloni, Sara Veloci, and Lorenzo Zammarchi, Clinica Malattie Infettive, Università di Firenze Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy, E-mails: bartoloni@unifi.it, sara.veloci@gmail.com, and lorenzozammarchi@hotmail.it. Lina Tomasoni, Alessandro Pini, and Francesco Castelli, Istituto Malattie Infettive e Tropicali, Università di Brescia, Brescia, Italy, E-mails: l.tomasoni@infettivibrescia.it, alessandropini79@yahoo.it, and castelli@med.unibs.it. Filippo Bartalesi, SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy, E-mail: bartalesif@aou-careggi.toscana.it. Luisa Galli, Dipartimento di Pediatria, Università degli Studi di Firenze, Firenze, Italy, E-mail: luisa.galli@unifi.it. Spartaco Sani, UO Malattie Infettive, Spedali Riuniti Livorno, Livorno, Italy, E-mail: spartacosani@virgilio.it.

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