COMPARISON OF INTRAMUSCULAR AND INTRAVENOUS QUININE FOR THE TREATMENT OF SEVERE AND COMPLICATED MALARIA IN CHILDREN

Abstract

Intravenous (IV) quinine is the standard treatment for severe malaria where chloroquine resistant Plasmodium falciparum is found. Because of the advantages of intramuscular (IM) administration, a study was performed to compare these methods of administration in children with severe and complicated malaria. The study population was children from 6 months to 7 years of age, all of whom had asexual Plasmodium falciparum in the blood smear and at least one of the following: rigorously defined cerebral malaria; probable cerebral malaria; hyperparasitemia; or severe malaria. Exclusions included those who had: received quinine within a week; received an excessive dose of chloroquine within 48 hours; a history of quinine intolerance; or signs of circulatory shock or hemorrhagic diathesis. Patients were randomly allocated to one of two treatment groups: 1) quinine dihydrochloride administered intravenously with an initial loading dose of 20 mg/kg in 5% glucose, 20 mL/kg over 4 hours, followed by 10 mg/kg in 5% glucose, 10 mL/kg intravenously over 2 hours every 8 hours; 2) quinine dihydrochloride 10 mg/kg by deep IM injection at alternating sites every 8 hours. A loading dose was applied by repetition of the initial dose after 2 hours. Treatment was changed to oral medication 10 mg/kg every 8 hours when they were well enough to do so. There were 47 patients in the IV group and 57 in the IM group. The two groups were comparable in all aspects including malnutrition, anemia, and splenomegaly. Seventeen percent (17%) of the IV group died and 7% of the IM group died. The mean parasite clearance, fever clearance, and coma clearance times were similar in both groups. There were two sterile abscesses in the IM group. The authors conclude that IM quinine is as effective as IV in children with severe and complicated malaria.