Treatment of uncomplicated plasmodium falciparum malaria with quinine-doxycycline combination therapy.
OBJECTIVE
To assess the efficacy and tolerability of quinine-doxycycline combination therapy in uncomplicated falciparum malaria in terms of malarial parasite clearance from peripheral blood.


METHODS
One hundred adult males were included in the study. Malarial parasite counts in peripheral blood films were determined at the time of admission and then 12 hourly until clearance and thereafter weekly for 28 days (4 weeks). Treatment was started with quinine sulphate 10 mg of salt/kg body weight 8 hourly orally for a minimum period of 3 days and maximum of 7 days along with doxycycline 100 mg 12 hourly orally for 7 days. Primary efficacy outcome measure was early treatment failure, whereas secondary efficacy outcome measure was late treatment failure. Tolerability outcome measure was the development of treatment related adverse effects resulting in discontinuation from the study.


RESULTS
The primary efficacy outcome measure of the study i.e. malarial parasite index declined from a mean of 6.34 (SD +/- 2.83) before treatment to zero at day 7 of treatment. Parasite clearance time was 1-7 days (mean 3.58, SD +/- 1.28). Mean duration of quinine treatment till clearance of malarial parasites was 4.63 days (SD +/- 1.38). Mean duration of fever was 2.96 days (range 1 to 6 days). There was no early or late treatment failure. There was no relapse during the 28 days follow up period. Drug related side effects were mild and did not warrant discontinuation of treatment in any patient.


CONCLUSIONS
Quinine-doxycycline combination is effective in southern Pakistan. Randomized controlled trials are needed to further validate the claim.
Ejaz
Amer
A
Combined Military Hospital, Kharian Cantt, Karachi.
Haqnawaz
Khurram
K
Hussain
Zakir
Z
Butt
Rafi
R
Awan
Zaheer Iqbal
ZI
Bux
Hussain
H
D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000494:pharmacology* / Q000627:therapeutic use; D004318:Doxycycline / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006772:Hospitals, Military; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010963:Plasmodium falciparum / Q000187:drug effects*; D011803:Quinine / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
D000962:Antimalarials; D011803:Quinine; D004318:Doxycycline