title: Intrarectal quinine for treating Plasmodium falciparum malaria: a systematic review.
abstract: BACKGROUND
  In children with malaria caused by Plasmodium falciparum, quinine administered rectally may be easier to use and less painful than intramuscular or intravenous administration. The objective of this review was to compare the effectiveness of intrarectal with intravenous or intramuscular quinine for treating falciparum malaria.
  
  
  METHODS
  All randomized and quasi-randomized controlled trials comparing intrarectal with intramuscular or intravenous quinine for treating people with falciparum malaria located through the following sources were included: Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS and CINAHL. Trial quality was assessed and data, including adverse event data, were extracted. Dichotomous data were analysed using odds ratios and continuous data using weighted mean difference.
  
  
  RESULTS
  Eight randomized controlled trials (1,247 children) fulfilled the inclusion criteria. The same principal investigator led seven of the trials. Five compared intrarectal with intravenous quinine, and six compared intrarectal with intramuscular treatment. No statistically significant difference was detected for death, parasite clearance by 48 hours and seven days, parasite and fever clearance time, coma recovery time, duration of hospitalization and time before drinking began. One trial (898 children) reported that intrarectal was less painful than intramuscular administration.
  
  
  CONCLUSIONS
  No difference in the effect on parasites and clinical illness was detected for the use of intrarectal quinine compared with other routes, but most trials were small. Pain during application may be less with intrarectal quinine. Further larger trials, in patients with severe malaria and in adults, are required before the intrarectal route could be recommended.
authors.affiliation: Arrowe Park Hospital, Wirral Hospital NHS Trust, Upton, Wirral, UK. michael.eisenhut@talk21.com
authors.forename: Michael
authors.initials: M
authors.lastname: Eisenhut
authors.forename: Aika
authors.initials: A
authors.lastname: Omari
authors.forename: Harriet G
authors.initials: HG
authors.lastname: MacLehose
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D000962:Antimalarials / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007260:Infusion Pumps; D007273:Injections, Intramuscular / Q000379:methods; D016778:Malaria, Falciparum / Q000188:drug therapy*; D011803:Quinine / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000962:Antimalarials; D011803:Quinine