Severe P. falciparum malaria requires urgent treatment with parenteral antimalarial agents. Quinine is the drug of choice unless the malaria was definitely acquired in a chloroquine-sensitive area. Quinidine may be used as an alternative to quinine if the latter is not available. Drugs with short half-lives (quinine, quinidine, artemesinin) should be given for at least 7 days if given alone. Shorter treatments are required for drugs with longer half-lives (chloroquine, mefloquine, pyr-imethamine/sulphadoxine). It is important to distinguish between base and salt when calculating the drug dose. Chloroquine, mefloquine and primaquine prescriptions are usually written as the amount of base, whereas quinine and halofantrine are written as the amount of salt. Always check the doses carefully.
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