title: Efficacy and safety of quinine loading dose in patients with severe falciparum malaria at a tertiary care hospital in Pakistan.
abstract: OBJECTIVE
  To compare the clinical outcomes of a loading dose regimen of quinine with a uniform dose regimen in patients with severe falciparum malaria.
  
  
  METHODS
  A retrospective chart review of 315 patients admitted with severe falciparum malaria and treated with quinine at a tertiary care teaching hospital of Karachi, Pakistan during 1999-2006 was conducted. Group A with 103 patients (32.7%) was given an initial loading dose of quinine while group B with 212 patients (67.3%) did not receive the loading dose. The two groups were compared in terms of reduction of parasite load, resolution of fever, recovery of consciousness and incidence of adverse effects. Outcome parameters were measured on the third day of therapy.
  
  
  RESULTS
  More individuals in group A (62.1%) were afebrile as compared to group B (54.7%) at day 3 of therapy. Patients in group B showed greater reduction in parasitaemia (47.2% at baseline to 4.7% on day 3) as compared to group A (56.3 % at baseline to 9.7% on day 3). Following therapy, fewer patients in group B had altered consciousness (7.1% at baseline to 4.7% on day 3) as compared to patients in group A (7.8% at baseline to 5.8% on day 3). However, these associations were not statistically significant. The incidence of thrombocytopenia was higher in Group A (5.8%) as compared to Group B (0.9%).
  
  
  CONCLUSIONS
  Although quinine loading dose may be more effective than uniform dose in rapid fever clearance; it also appears to be associated with higher toxicity. Uniform dose of quinine may be prescribed in severe falciparum malaria in view of its better safety profile.
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Tariq
authors.forename: Taimur
authors.initials: T
authors.lastname: Saleem
authors.forename: Hamid
authors.initials: H
authors.lastname: Ullah
authors.forename: Vikram
authors.initials: V
authors.lastname: Mehraj
authors.forename: Abdul Jawwad
authors.initials: AJ
authors.lastname: Samdani
authors.forename: Syeda Hena
authors.initials: SH
authors.lastname: Kazmi
authors.forename: Syed Imran
authors.initials: SI
authors.lastname: Ayaz
authors.forename: Mehmood
authors.initials: M
authors.lastname: Riaz
authors.forename: Mohammed Junaid
authors.initials: MJ
authors.lastname: Patel
authors.forename: Jaweed
authors.initials: J
authors.lastname: Akhtar
authors.forename: Mohammed Asim
authors.initials: MA
authors.lastname: Beg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007262:Infusions, Intravenous; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D059208:Parasite Load; D018512:Parasitemia / Q000188:drug therapy*; D011803:Quinine / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials; D011803:Quinine