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] |