A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. The patient was started on a 7 day course of quinine and clindamycin. A few days later, the patient called your office reporting tinnitus, headache, nausea, vomiting, diarrhea, abdominal pain, dizziness, flushing, visual disturbances, chest fluttering and shortness of breath. Physical examination showed fixed, dilated pupils. Fundoscopy revealed retinal artery spasm, disc pallor, and macular edema. ECG showed QT prolongation. What is the next best step in the management of this patient?
