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December 4, 1967

Chloroquine-Resistant Falciparum Malaria

JAMA. 1967;202(10):989. doi:10.1001/jama.1967.03130230115029

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To the Editor:—  The Journal (200:886, 1967) featured an important editorial on falciparum malaria. It is certainly vital to alert the clinician to the problem of chloroquine resistance. The editorial outlines well the alternative treatment being used.I am not sure, however, that one statement is entirely warranted. "Aggressive and prompt therapy with quinine" is recommended in patients with cases of falciparum malaria from those areas where resistant cases are known to occur. It must be kept in mind that not all patients from such areas fail to be cured with chloroquine and, furthermore, that resistance in many instances does not mean absence of clinical response. Experience indicates that what often happens is that fever is controlled for from one to three weeks. Parasites may or may not persist in the blood. Then there is a recurrence.Since quinine may precipitate an acute hemolytic reaction in falciparum malaria (black-water