Malaria Treatment & Prevention

Dear sir,
I think the treatment for severe malaria case it's easy to use artemether IM in rural area where the quinine IV is not easy to use buy the unqualified nurse/health staff in the remote area (strong side effect). In Cambodia we keep quinine for second line of treatment if artemether is not work. Quinine is still very effective drug to treat all malaria cases, just strong side effect and long treatment(7days) that not good for compliance.
Thanks. Dr. Duong Socheat,
Director of CNM, Cambodia

RE: loading dose of quinine
This does seem to be the standard of care, and it used for drugs when a rapid theraputic level is needed (such as severe disease)
as far as the evidence: there is a Cochrane Review:
Cochrane Database Syst Rev. 2004;(3):CD003341.
"High first dose quinine regimen for treating severe malaria."
Lesi A, Meremikwu M.

Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.

4 trials were sufficient to analyze; Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to directly demonstrate an impact of loading dose on risk of death. (however the was a trend of reduced deaths with loading dose)

RE: Quinine vs IM Artemether: not alot of data in severe disease
Indian Pediatr. 2003 Oct;40(10):939-45.
"A comparative clinical trial of artemether and quinine in children with severe malaria."
Huda SN, Shahab T, Ali SM, Afzal K, Khan HM.
Department of Pediatrics, Jawaharlal Nehru Medical College, AMU, Aligarh, U.P. India.

Equivalent outcomes:

the bottom line is that someone with severe malaria-including African children, the drug of choice is now Artesunate
(Lancet : Lancet. 2010 Nov 13;376(9753):1647-1657. Epub 2010 Nov 7 ...

RE: loading dose of quinine
This does seem to be the standard of care, and it used for drugs when a rapid theraputic level is needed (such as severe disease)
as far as the evidence: there is a Cochrane Review:
Cochrane Database Syst Rev. 2004;(3):CD003341.
"High first dose quinine regimen for treating severe malaria."
Lesi A, Meremikwu M.

Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.

4 trials were sufficient to analyze; Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to directly demonstrate an impact of loading dose on risk of death. (however the was a trend of reduced deaths with loading dose)

RE: Quinine vs IM Artemether: not alot of data in severe disease
Indian Pediatr. 2003 Oct;40(10):939-45.
"A comparative clinical trial of artemether and quinine in children with severe malaria."
Huda SN, Shahab T, Ali SM, Afzal K, Khan HM.
Department of Pediatrics, Jawaharlal Nehru Medical College, AMU, Aligarh, U.P. India.

Equivalent outcomes:

the bottom line is that someone with severe malaria-including African children, the drug of choice is now Artesunate
(Lancet : Lancet. 2010 Nov 13;376(9753):1647-1657. Epub 2010 Nov 7.
"Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial."

(10% death in quinine vs approx 8% artesunate)

however if not quite severe malaria, probably IM artemether or quinine is fine

Johanna, Thank you for the wonderful, complete and well documented summary. Vince

Here in Burundi we have access to Artesunate+ amodiaquine (association) and quinine. We have documented several cases of unsuccessful treatment with artesunate + amodiaquine. However quinine always worked very well. The loading dose of 20mg/kg of quinine for severe cases of malaria usually works fine.

Bazile