Intervention Review

High first dose quinine regimen for treating severe malaria

  1. Afolabi FE Lesi1,*,
  2. Martin M Meremikwu2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 18 FEB 2009

DOI: 10.1002/14651858.CD003341.pub2


How to Cite

Lesi AFE, Meremikwu MM. High first dose quinine regimen for treating severe malaria. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003341. DOI: 10.1002/14651858.CD003341.pub2.

Author Information

  1. 1

    College of Medicine of the University of Lagos, Department of Paediatrics and Child Health, Lagos, Nigeria

  2. 2

    University of Calabar Teaching Hospital, Department of Paediatrics, Calabar, Cross River State, Nigeria

*Afolabi FE Lesi, Department of Paediatrics and Child Health, College of Medicine of the University of Lagos, Lagos, PMB 12003, Nigeria. afolabilesi@hotmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 JUL 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Quinine is used for treating severe malaria. There are arguments for giving an initial high dose. We examined the evidence for and against this policy.

Objectives

To assess the clinical outcomes and adverse events of a high first (loading) dose regimen of quinine compared with a uniform (no loading) dose regimen in people with severe malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (February 2009), CENTRAL (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to February 2009), EMBASE (1974 to February 2009), LILACS (1982 to February 2009), and conference proceedings for relevant abstracts. We also contacted researchers working in the field and checked the reference lists of all studies.

Selection criteria

Randomized controlled trials comparing a high first (loading) dose of intravenous quinine with a uniform (no loading) dose of intravenous quinine in people with severe malaria.

Data collection and analysis

Two reviewers independently assessed the risk of bias in the trials and extracted data (including adverse event data). We used Review Manager 5.0 to analyse the data: risk ratio (RR) for binary data and mean difference (MD) for continuous data with 95% confidence intervals (CI). We contacted study authors for additional information.

Main results

Four trials (n = 144) met the inclusion criteria. Loading dose was associated with fewer deaths, but this was not statistically significant (RR 0.62, 95% CI 0.19 to 2.04; 3 trials). Loading dose was associated with faster clearance of parasites (WMD -7.44 hours, 95% CI -13.24 to -1.64 hours; 2 trials), resolution of fever (WMD -11.11 hours, 95% CI -20.04 to -2.18 hours; 2 trials). No statistically significant difference was detected for recovery of consciousness, neurological sequelae, or convulsions, but the numbers were small.

Authors' conclusions

Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to directly demonstrate an impact of loading dose on risk of death.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Initial high dose of quinine to treat severe malaria

People with severe malaria are unconscious, have difficulty breathing, may convulse, and have low blood sugar. They need treating quickly.

Quinine given intravenously or intramuscularly has been used for some years to treat severe malaria. It is particularly helpful as it works against parasites resistant to chloroquine, which used to be an effective and commonly used drug.

The World Health Organization recommends that doctors give people with severe malaria an initial high dose (loading dose) of intravenous quinine followed by lower quinine maintenance doses. This is to get an effective drug concentration in the blood. Several different quinine loading doses, maintenance doses, and dose intervals have been examined. There are some concerns about adverse effects in children.

The authors of this review wanted to summarize the benefits and harms of different quinine dosing regimens. They identified four relevant trials with 144 participants. A high initial dose of quinine reduced fever clearance time and parasite clearance time, but there were too few data to describe the impact on death. No difference was detected for recovery of consciousness and other neurological symptoms, but there were probably too few participants to detect differences.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

高初始劑量奎寧使用於嚴重瘧疾之治療

奎寧被用來治療嚴重瘧疾。但給予高初始劑量的奎寧仍有爭議。我們檢視這方面的證據以作為政策上的依據。

目標

評估罹患嚴重瘧疾者使用高初始(初載)劑量奎寧與相同(無初載)劑量奎寧之臨床結果及不良事件之比較。

搜尋策略

我們搜尋了the Cochrane Infectious Diseases Group's trials register (2006年七月), CENTRAL (The Cochrane Library Issue3, 2006), MEDLINE (1966 年至 2006年七月), EMBASE (1974 年至 2006年七月), LILACS (1982年至 2006年七月),以及會議報告的相關摘要。我們也聯絡了在該領域工作的研究學者,並檢視了所有研究的參考文獻目錄。

選擇標準

隨機對照試驗,靜脈給予罹患嚴重瘧疾病人高初始(初載)劑量奎寧與給予相同(無初載)劑量奎寧之比較。

資料收集與分析

兩位審查員獨立評估所有試驗的方法學品質以及擷取資料(包括不良事件資料)。我們使用Review Manager 4.2來分析數據:類別變項的數據(dichotomous data)是以相對風險(relative risk, RR)來計算;連續變項的數據(continuous data)則是以加權平均數差(weighted mean difference, WMD)及95%信賴區間(95% confidence intervals, CI)來表示。

主要結論

共4個試驗(n = 144)符合納入標準。初載劑量(loading dose)組死亡人數較少,但統計上並無顯著差別 (RR 0.62, CI 0.19 to 2.04,3個試驗)。初載劑量組對寄生蟲的清除較快(WMD −7.44 小時,CI −13.24 to −1.64小時,2 個試驗),發燒緩解較快(WMD −11.11小時,CI −20.04 to2.18小時,2 個試驗)。但在意識恢復、神經後遺症或是痙攣上並無統計學上的顯著差異,不過個案數並不多。

作者結論

使用初載劑量奎寧能減少發燒緩解時間及寄生蟲清除時間。所得數據尚不足以直接呈現初載劑量對於死亡風險的影響。

翻譯人

本摘要由三軍總醫院洪乃勻翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結