In areas where chloroquine-resistant P. falciparum is common, a combination of a rapidly acting blood schi-zonticide and pyrimethamine-sulfadoxine may be the treatment of choice. An acute attack of malaria caused by chloroquine-resistant P. falciparum complicated by renal failure or cerebral manifestations may be terminated with parenteral quinidine gluconate alone or with oral pyrimethamine and sulfadiazine. Oral mefloquine has been used in place of chloroquine in uncomplicated infections with chloroquine-resistant organisms, but serious CNS side effects (e.g., flashbacks) are frequently seen with its use. Consequently, the atovaquone-proguanil combination is now considered as effective as and better tolerated than mefloquine.
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