Consensual treatment of plasmodium falciparum malaria does not lead to adequate quinine blood concentrations.
Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.
Roger
P-M
PM
Service des Maladies Infectieuses et Tropicales, Hôpital de l'Archet, Centre Hospitalier Universitaire, Nice, France. roger.pm@chu-nice.fr
Marty
P
P
Prestifilippo
L
L
Garaffo
R
R
Hyvernat
H
H
Dunais
B
B
Chaillou
S
S
Delaunay
P
P
Bernardin
G
G
Mattéi
M
M
Le Fichoux
Y
Y
Dellamonica
P
P
D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D002985:Clinical Protocols / Q000592:standards; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood* / Q000188:drug therapy*; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects / Q000469:parasitology; D011803:Quinine / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics / Q000627:therapeutic use; D014944:World Health Organization / Q000458:organization & administration
D000962:Antimalarials; D011803:Quinine; D003404:Creatinine