A safe and effective consecutive-infusion regimen for rapid quinine loading in severe falciparum malaria.
Recommended initial treatment of severe chloroquine-resistant falciparum malaria consists of a 4-h loading infusion of 20 mg of quinine dihydrochloride (salt)/kg of body weight. To achieve and maintain therapeutic blood quinine concentrations (10 mg/l) safely and rapidly, a consecutive-infusion regimen (7 mg of salt/kg of body weight over 30 min followed by 10 mg of salt/kg of body weight over 4 h) based on pharmacokinetic parameters in cerebral malaria has been suggested. This regimen was evaluated in 16 adults (6 male, 10 female; mean age, 25.9 years) with severe falciparum malaria. Plasma quinine concentrations (mean +/- SE) were 8.7 +/- 1.2 mg/l at 30 min and 11.0 +/- 1.8 mg/l at 4.5 h. There was no electrocardiographic evidence of serious cardiotoxicity during the 4.5-h infusion period, and systolic blood pressure fell by greater than 10 mm Hg in only one patient. Parasite clearance in 13 surviving patients (median count on admission, 438 x 10(3)/microliters; range, 500-122 x 10(4) took an average of 71 h (range, 9-115). This regimen is safe, effective, and suitable for use in an intensive care unit.
Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidot University, Thailand.
T M
TM
Davis
W
W
Supanaranond
S
S
Pukrittayakamee
J
J
Karbwang
P
P
Molunto
S
S
Mekthon
N J
NJ
White
D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010963:Plasmodium falciparum; D011674:Pulse / Q000187:drug effects; D011803:Quinine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
D011803:Quinine