Treatment of Malaria

To the Editor.—  I refer to the recently published report of Plasmodium falciparum infection treated with exchange blood transfusion (1983; 249:244). Several aspects of the report deserve comment. Although there have been modifications in the treatment of the patient with severe malaria since this report was submitted, the principles have not changed. Attaining therapeutic serum levels of an appropriate antimalarial drug as quickly as possible during the critical first 24 hours seems to be the most important aspect of therapy. For a dangerously ill patient from a chloroquine-resistant area, the treatment of choice seems to be parenteral quinine sulfate, given as a loading dose of 20 mg/kg during four hours and then in maintenance dosages of 10 mg/kg three times daily.¹With regard to prophylaxis, it is difficult to know what to recommend for someone going to eastern Thailand. There is not only chloroquine and pyrimethamine-sulfadoxine (Fansidar) resistance, but