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The Journal of the Royal Institute of Thailand Volume III - 2011 155 Sasithon Pukrittayakamee, Arjen Dondorp Sub-Saharan Africa, in 11 study sites over 9 countries (Dondorp et al, 2010). The study included 5,425 children with severe falciparum malaria, and the overall mortality was around 10%. However, mortality in children treated with intravenous or intrauscular artesunate was 22.5% lower than with quinine, a highly significant difference. The trial was published end of 2010. Simultaneously, the Chinese artesunate product obtained ùWHO-prequalificationû, which is a quality assurance certificate issued by the WHO. This was early 2011 followed by another change in the WHO guidelines for the treatment of severe malaria, now recommending artesunate for all patients with severe malaria, irrespective of age or endemic setting. The next step will have to be a wide deployment of parenteral artesunate in all countries of the world with important malaria mortality. General use of artesunate over quinine for the treatment of severe falciparum malaria has the potential to safe hundreds of thousands of precious lives each year. Table 1. Timeline for Quinine Discovery 1620-1630 The first written record of a malaria cure with cinchona bark in Peru 1629 Use to treat Countess of Chincho ´ n in Lima 1633 The cinchona bark was brought to Spain 1640s Directions for the use of the bark were published (Juan de Lugo) 1649 Cinchona to treat the young Louis XIV 1655 Antimus Conygius, Fabri wrote in the first paper on cinchona. 1658 Prescription of cinchona (ùJesuitsû barkû) in England by Robert Brady 1666 Thomas Sydenham, an eminent English physician, published a book called Method for Curing the Fever (Methodus curandi febres) 1670s Robert Talbor develops an infusion of cinchona powder in white wine and uses it as a ùsecret remedyû to cure of agues 1679 King Charles II was treated with Talborûs remedy 1742 Linnaeus, a Swedish botonist, classifies the Peruvian bark and names the tree cinchona after the Countess 1817 Joseph Pelletier and Jean Biename Caventou isolated quinine 1900s Widespread use of cinchona came about because of the colonizing 1844/1910 Sporadic resistance to quinine reported 1980 Quinine as a first line drug for treatment of severe malaria WHO 2006/2011 Quinine as alternative to artesunate for severe malaria in adults and children 150-159_mac9 5/9/12, 11:21 PM 155