The treatment of Plasmodium falciparum malaria requires a safe and effective therapeutic treatment regimen, which in turn has high impact on the transmission. In 2006, an artesunate (AS)-mefloquine (MQ) treatment program was implemented in Antioquia. In addition, primaquine (PQ) was added to eliminate malaria gametocytes in the bloodstream. The efficacy and gametocytocidal activity was evaluated for two treatment regimens, AS-MQ-PQ and AS-MQ, in patients with uncomplicated P. falciparum malaria. Between April 2007 and February 2008, 50 patients were recruited for the trial in Turbo, Antioquia. A randomized clinical trial was conducted. Treatment compliance was supervised, with a clinical and parasitological assessment on days 1, 2, 3, 7, 14, 21, 28, 35, and 42 to evaluate response rate according to the WHO 2003 protocol. Clinical response and parasite elimination efficacy of AS-MQ (with or without PQ) was 100% (95% CI 86.3%-100%), and parasitemia and fever were absent on day 3 of treatment in all patients. Gametocyte elimination was superior when PQ was used--92% (95% CI: 74%-99%) of patients who received PQ had no gametocytes on day 3, compared to 78.3% (95% CI: 59%-93%) of patients who only received AS-MQ. Furthermore, circulating gametocytes were eliminated on average one week faster when the AS-MQ-PQ treatment scheme was used compared to the scheme without PQ. These studies recommend the use of AS-MQ to treat P. falciparum malaria given its good therapeutic efficacy. However, further assessment is suggested concerning the benefit of adding PQ to this treatment scheme.

Severe falciparum malaria is a medical emergency that is associated with a high rate of mortality, even when treated in an Intensive Care Unit. Until recently, intravenous quinine was the standard treatment; however, artemisinin derivatives are now regarded as the first-line treatment for multidrug-resistant falciparum malaria. Although several studies have demonstrated the superiority of Artesunate, this drug is not licensed in many countries. This article describes the case of an HIV-positive patient, who returned from Africa and presented with 10% parasitemia and clinical signs of severe falciparum malaria; this individual was successfully treated with a combination of artesunate and quinine. Artesunate was imported from the foreign market, and written consent for its administration was obtained in advance. Parasite clearance was rapidly achieved; however, on day IV, the patient developed acute respiratory distress syndrome that required mechanical ventilation. The patient was extubated on day XIV and discharged on day XXV. Due to its rapid action, artesunate was likely responsible for the good clinical outcome in this case; however, in order to clarify the role of this new combination therapy, further studies are required.