Chloroquine resistance Chloroquine resistance has been documented in virtually all areas in which falciparum malaria is known to occur. There is certainly consensus that chloroquine has little efficacy in S-E Asia and it has been argued that its continued use in parts of Africa should be discontinued. Quinine is regarded by most authorities as the drug of choice in severe falciparum malaria. However the dose, mode of administration, and toxicity remain controversial. Quinine is active against the sequestered, late-stage parasites, and clears the blood film less rapidly than chloroquine.
Early therapy correlates with increased survival.
Oral quinine therapy is substituted as soon as the patient is able to swallow, and continued for 5-7 days. Therefore severe toxicity, which is due to unbound quinine, is not common in patients with malaria, though the same doses given to a healthy volunteer would be highly toxic. Quinine is well absorbed by intramuscular injection, though it is irritant. Abscesses may form at the sites of injection, though the risk of this is reduced by observing scrupulously sterile technique and by using the anterior thigh rather than the buttock, to avoid injection into fat. Resistance to quinine is increasing in S-E Asia.