Management of Plasmodium falciparum malaria.

Measures of malaria control have proved inadequate in many parts of the tropics. The recent rise in the incidence of malaria has been associated with the spread of drug-resistant strains of Plasmodium falciparum. Chloroquine therapy is now ineffective in many parts of Asia and South America, and resistance to this drug is emerging in Africa. There are few alternative drugs available. Quinine remains effective against P. falciparum in Southeast Asia. Reappraisal of quinine therapy has led to important modifications in dosage recommendations and recognition of a major complication of severe malaria associated with its use--hypoglycaemia. Severe malaria has been neglected as a subject for clinical investigation, and there is little information available on which to base rational treatment. Most of the drugs used in addition to antimalarial agents for cerebral malaria have not been critically tested, except dexamethasone which has been shown to be harmful. Simple, but difficult to organize, intensive nursing of patients with cerebral malaria will improve the prognosis. However, even in the best hands, the mortality rate never falls below 20%.