The art of medicine Artesunate versus quinine: the controlled trials watershed

22 Apr 2023
Conrad Keating

Earlier this century, two inter-related randomised controlled trials—the first in southeast Asia and a second in Africa—provided an incontrovertible breakthrough in the treatment of severe falciparum malaria. The trials, of artesunate versus quinine, proved beyond doubt for the first time that quinine, which had long been the mainstay of treatment for severe malaria, was no longer the most effective drug available, and thus catalysed a watershed in clinical practice and policy making. Like almost all decisive moments, this advance had a backstory that stretched several decades.