Availability of Intravenous Quinidine for falciparum Malaria

To the Editor: Intravenous quinidine, the treatment of choice for patients with life-threatening falciparum malaria, is no longer available at many hospitals. A four-year-old boy, born in the United States, was brought to San Francisco General Hospital in April 1996 after two days of fever, malaise, and watery diarrhea that began three weeks after his return from a three-week visit to Sierra Leone. He had not received malaria chemoprophylaxis. The child was intermittently somnolent and had an enlarged spleen. The hematocrit was 28.1 percent, the platelet count 71,000 per cubic millimeter, and the peripheral-blood smear showed that 8 to 10 . . .