To the Editor:—
Dr. Shookoff's timely letter brings up a question familiar to all physicians: Which of two courses of action is least hazardous to the patient? In the present instance, when faced with possible chloroquine-refractory malaria, a potentially and sometimes rapidly fatal illness, should the physician risk the time required to evaluate the response to chloroquine or should he employ a known effective drug, quinine, and accept possible toxicity?Dr. Shookoff reminds us that quinine may produce an acute hemolytic episode. While this statement appears frequently in print, there is no agreement amongst malariologists as to the frequency with which quinine is the actual precipitating factor. He advocates a trial with chloroquine, "unless the patient is in a precarious condition," and evaluation of the response over a 24- to 48-hour period. The problem here lies in the notorious lack of ability to truly evaluate the status of the falciparum
Blount MRE, Tigertt WD, Blount RE. Chloroquine-Resistant Falciparum Malaria. JAMA. 1967;202(10):989. doi:10.1001/jama.1967.03130230115030
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