Acute Falciparum Malaria

The cases described strongly support the effectiveness of quinine and pyrimethamine therapy when falciparum malaria is diagnosed early and treated promptly. Two thousand and three acute falciparum malaria patients were given quinine sulfate, 650 mg every 8 hr for 14 days, and pyrimethamine, 25 mg base every 12 hr for a total of 6 doses. (A slightly higher pyrimethamine dose was given to the earlier patients in the series.) Response to therapy was seen in all patients, and no deaths occurred. Despite the use of such potent drugs dangerous side-effects were encountered infrequently. Adverse reactions were seen primarily in the hematologic system through hemolysis, or bone marrow depression, or both. Complications in the series included cerebral malaria in 24 patients; anemia requiring transfusion, 18; severe pancytopenia, 11; and malarial hemoglobinuria, 8. Clinical management of malaria and its complications are discussed. Chemoprophylaxis used by units from which these patients were derived included chloroquine, 300 mg base; and primaquine, 45 mg base, weekly; and diophenyldiaminosulfone, 25 mg daily. These drugs along with field mosquito discipline and the existing efficient medical evacuation system contributed to the absence of fatalities in the present series.