title: Combined intravenous treatment with artesunate and quinine for severe malaria in Italy.
abstract: 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.
authors.affiliation: Dipartimento Area Critica Medico-Chirurgica, Università degli Studi di Firenze, Firenze, Italy. bartoloni@unifi.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.forename: Lina
authors.initials: L
authors.lastname: Tomasoni
authors.forename: Filippo
authors.initials: F
authors.lastname: Bartalesi
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.forename: Spartaco
authors.initials: S
authors.lastname: Sani
authors.forename: Sara
authors.initials: S
authors.lastname: Veloci
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zammarchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pini
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D007558:Italy / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D018512:Parasitemia; D011803:Quinine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D014195:Travel
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D011803:Quinine