Quinine in severe infection of P. falciparum

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Used as the first line antimalarial drug in the treatment of severe infection in UK (1).

If the patient has a severe infection with P. falciparum (or unknown species) then:

Treat with quinine dihydrochloride (adult regime):

• loading dose: 20mg/kg quinine dihydrochloride in 5% dextrose or dextrose saline. This is given over 4 hours by i.v. infusion - then after 8 hours maintenance dose is given
• maintenance dose: 10 mg/kg given over 4 hours by i.v. infusion 8hourly for first 48 hours (or until patient can swallow oral medication)
• in case of i.v. quinine continuing for more than 48 hours frequency of the dosing should be reduced to 12 hours
• a substitute loading dose regimen for adults are: 7 mg/kg quinine dihydrochloride over 30 min with an infusion pump followed by the maintenance dose
• when the patient is well enough to take oral medication, oral quinine should be substituted (600 mg 3 times a day) to complete a total course of 5-7 days and doxycycline 200 mg daily (or clindamycin 450 mg 3 times a day for pregnant women) should also be given for a total of 7 days

The respective summary of product characteristics must be consulted before prescribing the drugs mentioned.

Reference:

• 1. Lalloo DJ et al. UK malaria treatment guidelines. Journal of Infection 2007;54:111-121