Document Detail


Rectal versus intravenous quinine for the treatment of childhood cerebral malaria in Kampala, Uganda: a randomized, double-blind clinical trial.
MedLine Citation:
PMID:  17990227     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although artemesinin derivatives are promising for the treatment of severe Plasmodium falciparum malaria, intravenous quinine remains the most affordable treatment. However, administration of intravenous quinine is often not feasible in rural areas in Africa because of the lack of simple equipment or trained staff. We compared the efficacy and safety of intrarectal quinine with those of intravenous quinine in the treatment of childhood cerebral malaria. METHODS: In a randomized, double-blind clinical trial at Mulago Hospital (Kampala, Uganda), Uganda's national referral hospital, we studied 110 children aged 6 months to 5 years who had cerebral malaria. Patients were randomized to receive either intrarectal or intravenous quinine. Main outcome measures included parasite clearance time, fever clearance time, coma recovery time, time to sit unsupported, time to begin oral intake, time until oral quinine was tolerated, and death. RESULTS: Overall, there was no difference in the clinical and parasitological outcomes between the 2 groups (data are mean+/-standard deviation, intrarectal quinine group vs. intravenous quinine group): coma recovery time, 19.4+/-18.1 h versus 17.0+/-12.1 h; fever clearance time, 26.7+/-16.1 h versus 29.9+/-18.1 h; and parasite clearance time, 43.2+/-14.2 h versus 41.9+/-15.2 h. Mortality was similar in both groups; 4 of 56 patients in the intrarectal quinine group died, and 5 of 54 patients in the intravenous quinine group died (odds ratio, 1.3; 95% confidence interval, 0.3-5.2). Intrarectal quinine was well tolerated, and no major immediate adverse events occurred. CONCLUSIONS: Intrarectal quinine is efficacious and could be used as an alternative in the treatment of childhood cerebral malaria, especially in situations in which intravenous therapy is not feasible.
Authors:
Jane Achan; Justus Byarugaba; Hubert Barennes; James K Tumwine
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-10-22
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  45     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-11-08     Completed Date:  2007-12-13     Revised Date:  2008-07-21    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1446-52     Citation Subset:  IM    
Affiliation:
Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda.
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MeSH Terms
Descriptor/Qualifier:
Administration, Rectal
Antimalarials / administration & dosage*,  adverse effects,  therapeutic use*
Child, Preschool
Double-Blind Method
Humans
Injections, Intravenous
Malaria, Cerebral / drug therapy*
Quinine / administration & dosage*,  adverse effects,  therapeutic use*
Uganda
Chemical
Reg. No./Substance:
0/Antimalarials; 130-95-0/Quinine
Comments/Corrections
Comment In:
Clin Infect Dis. 2008 Jun 1;46(11):1795-6; author reply 1796-7   [PMID:  18462121 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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