Taste-masked quinine pamoate tablets for treatment of children with uncomplicated Plasmodium falciparum malaria.
Children with uncomplicated malaria are generally treated with oral medication, except those unable to take oral drugs. Even though quinine has shown to be effective in treatment of African children with uncomplicated malaria its high bitterness limited the paediatric use. This study aimed to develop taste-masked quinine tablets suitable for children and offering dosing flexibility to adjust the quinine dose in function of body weight.


METHODS
Insoluble quinine pamoate was used to formulate fast-disintegrating tablets, using a specific tablet design (rectangular tablet which can be divided into 8 subunits) to allow dosing flexibility. The physical properties of tablets were evaluated in vitro, as well as the quinine bioavailability in healthy adults (n=18) and the efficacy for treatment of children with uncomplicated Plasmodium falciparum malaria (n=56) using a 7-day regimen of 8 mg quinine/kg.


RESULTS
Quinine pamoate tablets complied with the pharmacopoeial requirements for mass uniformity, friability, content uniformity, breakability, disintegration and dissolution. The quinine pharmacokinetic parameters after single administration of a quinine pamoate tablet were similar to a commercially available quinine sulfate tablet. The fast decline in parasitemia (28.6%/24h), the reduction rate of fever (all children were apyretic after 72 h) and the steady state quinine plasma concentration (5.7-15.8 microg/ml) proved the efficacy of the quinine pamoate tablets against P. falciparum.


CONCLUSIONS
Fast-dispersible and taste-masked quinine pamoate tablets improved dosing accuracy, allowed easy administration and resulted in a high efficacy during the treatment of children with uncomplicated malaria.
Department of Pharmacy, National University of Rwanda, Butare, Rwanda.
E
E
Kayitare
C
C
Vervaet
E
E
Mehuys
P C
PC
Kayumba
J D
JD
Ntawukulilyayo
C
C
Karema
Van
V
Bortel
J P
JP
Remon
D000284:Administration, Oral; D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D001682:Biological Availability; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004339:Drug Compounding; D016503:Drug Delivery Systems / Q000379:methods*; D005079:Excipients / Q000737:chemistry; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects / Q000302:isolation & purification*; D011446:Prospective Studies; D011803:Quinine / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D012995:Solubility; D013607:Tablets; D013652:Taste Threshold; D055815:Young Adult
D000962:Antimalarials; D005079:Excipients; D013607:Tablets; D011803:Quinine