Table 8 Summary of quinine systematic reviews in the treatment of severe malaria in African children and recommendations for evidence-informed clinical practice
| Â | Clinical Issue | Recommendation | Evidence quality/strength of recommendation |
|---|---|---|---|
Systematic review 1: Is there a value in administration of a loading dose of quinine in African children with severe malaria? | Quinine loading dose [9] | Loading dose results in faster clearance of malaria parasites from the blood stream and thus faster clearance of fever and thus loading dose should be administered, with monitoring and patient/care giver support for episodes of partial hearing loss adverse event | Moderate |
Systematic review 3a: What is the effectiveness of IV-administered quinine compared to IM-administered quinine in African children with severe malaria | The clinical outcome of IV-administered quinine vs. IM-administered quinine is equivocal in the treatment of African children with severe malaria. However, due to reported side effects with IM route, such as risk of abscess and pain, the IV route is preferred. | Low to very low | |
Systematic review 3b: What is the pharmacokinetics of IV-administered quinine compared to IM-administered quinine in African children with severe malaria | Pharmacokinetic profile of the old and new Kenyan dosing regimen are similar | Low | |
Systematic review 4: Is there a link between IV-administered quinine and risk of hypoglycaemia in African children with severe malaria? | The risk of hypoglycaemia with quinine treatment in African children with severe malaria may be countered by administering the quinine at a low infusion rate. Glucose levels should be monitored due to hypoglycaemic risk that occurs due to the disease and/or quinine treatment, and should be treated with glucose infusion | Low to high | |
AQUAMAT Findings | Quinine vs artemisinin derivatives [2] | Artesunate is a superior treatment to quinine for African children with severe malaria and should be strongly considered for implementation as a first line treatment, taking contextual factors such as cost-effectiveness into account | High |