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September 16, 1983

Treatment of Malaria-Reply

Author Affiliations

Centers for Disease Control Atlanta

JAMA. 1983;250(11):1393. doi:10.1001/jama.1983.03340110016018

In Reply.—  The comments by Dr Watt raise several important points. As he notes correctly, since the publication of our case report, it has been documented that a loading dose (20 mg/ kg) of quinine sulfate results in a more rapid, sustained blood level required for schizonticidal action against P falciparum in Thailand.1 However, the loading dose can only be advocated for treating P falciparum strains derived from Thailand or Kampuchea, and then only for severe infections.While both the therapy and prophylaxis of P falciparum in Thailand, Kampuchea, and contiguous areas of Southeast Asia are difficult problems, it would be extremely unwise to advocate withholding prophylaxis from nonimmune persons. To date, the geographical distribution or prevalence of pyrimethamine-sulfadoxine resistance has not been defined. We believe that the drug may provide a degree of suppression against strains with low degrees of resistance and would, of course, provide greater degrees