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Table 8 Summary of quinine systematic reviews in the treatment of severe malaria in African children and recommendations for evidence-informed clinical practice

From: Treatment of African children with severe malaria - towards evidence-informed clinical practice using GRADE

  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 Quinine route of administration: IV vs IM [11, 13, 1820] 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 Quinine paediatric dose [1012, 1416] 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? Quinine and risk of hypoglycaemia [2, 2125] 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