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Table 2 Summary of studies of quinine for the treatment of severe malaria

From: Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Study site Year Sample size and Study population Drug Regimens Treatment outcome Comment Reference
Gambia 1992-1994 576 children
1-9 years Cerebral malaria
Intramuscular artemether (IMA)
Intravenous quinine (IVQ)
Mortality:
IMA:20.5%
IVQ: 21.5%
Neurological sequelae:
IMA: 3.3%
IVQ: 5.3%
Artemether is as effective as quinine in treatment of cerebral malaria in children [74]
Malawi 1992-1994 183 children
Cerebral malaria
Intramuscular artemether (IMA)
Intravenous quinine (IVQ)
Mortality:
IMA: 11%
IVQ: 16%
Survival with neurological sequelae:
IMA: 19%
IVQ: 12%
Results do not suggest artemether would confer a survival advantage over quinine [73]
Kenya 2000-2002 360 patients
1-60 years
Severe malaria
IV Quinine + oral malarone (QM)
IV Quinine +oral quinine (QQ)
Day 28 cure rates:
QM: 98.7%
QQ: 90%
Using malarone after IV quinine is safer and as effective as IV quinine +oral quinine [87]
Burkina Faso 2001-2002 898 children
1-15 years
Moderately severe malaria
Rectal quinine (RQ)
Intramuscular quinine (IMQ)
Early treatment failure (day 3):
RQ: 6%
IMQ: 3%
Fever recurrence on day 7:
RQ: 5%
IMQ: 10%
Rectal quinine had acceptable safety profile and could be used as early treatment for severe malaria [84]
Uganda 2002-2003 103 children
0.5-5 years
Cerebral malaria
Rectal artemether (RA)
Intravenous quinine (IVQ)
Mortality:
IVQ: 11.7%
RA: 19.2%
Rectal artemether was effective and well tolerated [76]
S.E Asia (Four countries) 2003-2005 1461 patients
>2 years
Severe malaria
Intravenous artesunate (IVA)
Intravenous quinine (IVQ)
Mortality:
IVA: 15%
IVQ: 22%
Absolute reduction in mortality: 34.7%
Intravenous artesunate should be treatment of choice for severe malaria in adults [20]
Uganda 2003-2004 110 children
0.5-5 years
Cerebral malaria
Rectal quinine (RQ)
Intravenous quinine (IVQ)
Mortality:
RQ: 7%
IVQ: 9%
Comparable clinical and parasitological outcomes
Rectal quinine was efficacious and could be used as a treatment alternative [79]
Africa (Nine countries) 2005-2010 5425 children
< 15 years Severe malaria
Intravenous artesunate (IVA)
Intravenous quinine (IVQ)
Mortality:
IVA: 8.5%
IVQ: 10.9%
Relative reduction in mortality: 22.5%
Parenteral artesunate should replace quinine as the treatment of choice for severe malaria [21]