Artemisinin compound has been used in China for treatment of malaria for over a thousand years. It has a broad spectrum activity against all stages of malarial parasite as well as all 4 plasmodium species. In falciparum malaria, it is also gametocidal. The elimination half-life is approximately 1 hour and thus they are potent short acting agents. The common side effects are gastrointestinal disturbances, dizziness, tinnitus and prolongation of QT interval.
Quinine is derived from bark of Cinchona tree. It acts on the mature trophozoite stage of parasite development. The elimination half life is about 11 hours in healthy individuals, 16 hours in uncomplicated malaria and 18 hours in severe malaria. Adverse effects are common and include tinnitus, impaired high pitch hearing, vomiting, urticaria, hemolytic-uremic syndrome, hypoglycemia and prolonged QT interval on ECG {seen in intravenous quinine}.
Since plasmodium falciparum has been found to be resistant to most of the currently used antimalarials, combination therapy with antimalarials is now recommended. The combination consists of two or more blood schizonticidal drugs and includes a combination of a short acting antimalarial with a long acting antimalarial. Both artemisinin compounds and
Quinine are short acting and have common side effects. Hence they should not be used together.
Combinations that are recommended are:
• Artesunate {short acting}plus
Mefloquine {long acting}
• Artesunate {short acting}plus Sulfadoxine-pyrimethamine {long acting}
• Artemether {short acting} plus
Lumefantrine {long acting}
• Quinine plus Clindamycin
• Quinine plus Tetracycline, Doxycycline
E-published: March 2011 Vol 8 Issue 3 Art No. 21