Antiparasitic treatment for severe Plasmodium falciparum malaria.

Antiparasitic treatment for severe imported malaria in metropolitan France uses antimalarial schizonticides, active against Plasmodium falciparum chloroquine-resistant strains. Quinine, still very efficient, is the basis of this treatment. Its pharmacokinetic and pharmacodynamic properties have been largely studied. Its neurosensorial and cardiovascular toxicity has been well demonstrated. Artemether can be an interesting alternative when confronted with polychemoresistant strains. Neurotoxicity was demonstrated in animal models. Antiparasitic treatment is usually quinine IV. There are differences in doses, therapeutic protocols, and maximum dosage. There is a controversy over whether or not to use a loading dose. The treatment surveillance mode is not well defined. Antibiotics and artemether can be used for specific indications. (C) 1999 Editions scientifiques et medicales Elsevier SAS.