From the Research
Artesunate and quinine should not be administered concurrently for the treatment of malaria. These medications are both effective antimalarials but are typically used as alternative options rather than in combination with each other. When treating severe malaria, artesunate is now the preferred first-line treatment due to its superior efficacy and safety profile compared to quinine, as shown in a study published in the Lancet in 2005 1. If artesunate is unavailable, quinine can be used as an alternative. For treatment of uncomplicated malaria, artesunate is typically combined with another antimalarial partner drug (such as amodiaquine, mefloquine, or lumefantrine) as part of artemisinin-based combination therapy (ACT), while quinine is usually combined with an antibiotic like doxycycline or clindamycin. Using both medications simultaneously could potentially increase the risk of adverse effects without providing additional therapeutic benefit. Both drugs work by different mechanisms to kill the malaria parasite, with artesunate acting rapidly to reduce parasite burden while quinine interferes with the parasite's ability to detoxify heme. A more recent study published in 2015 2 also supports the use of artesunate over quinine, demonstrating its ability to reduce parasite clearance time and duration of intensive care unit and hospital treatment in European patients with imported severe malaria. Another study published in 2007 3 compared artesunate with quinine for treating severe malaria and found that artesunate significantly reduced the risk of death and reduced parasite clearance time. If a patient is not responding adequately to one medication, the appropriate approach would be to switch completely to the alternative rather than adding the second agent. Some key points to consider when treating malaria include:
- Artesunate is the preferred first-line treatment for severe malaria
- Quinine can be used as an alternative if artesunate is unavailable
- Artemisinin-based combination therapy (ACT) is typically used for uncomplicated malaria
- Using both artesunate and quinine simultaneously may increase the risk of adverse effects without providing additional therapeutic benefit.