Intervention Review

Intrarectal quinine versus intravenous or intramuscular quinine for treating Plasmodium falciparum malaria

  1. Michael Eisenhut1,*,
  2. Aika AA Omari2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 27 AUG 2008

DOI: 10.1002/14651858.CD004009.pub3


How to Cite

Eisenhut M, Omari AAA. Intrarectal quinine versus intravenous or intramuscular quinine for treating Plasmodium falciparum malaria. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD004009. DOI: 10.1002/14651858.CD004009.pub3.

Author Information

  1. 1

    Luton & Dunstable Hospital NHS Foundation Trust, Paediatric Department, Luton, UK

  2. 2

    Alder Hey Children's Hospital, Liverpool, UK

*Michael Eisenhut, Paediatric Department, Luton & Dunstable Hospital NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK. michael.eisenhut@talk21.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 JAN 2009

SEARCH

 

Abstract

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

Background

In children with falciparum malaria, a proprietary quinine preparation (adjusted to make it less acidic) administered rectally may be easier to use and less painful than intramuscular or intravenous administration. However, rectal quinine may be less effective.

Objectives

To compare intrarectal quinine with intravenous or intramuscular quinine for treating malaria caused by Plasmodium falciparum.

Search methods

In May 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, LILACS, and CINAHL. We also searched conference proceedings, contacted individual researchers and a pharmaceutical company, and checked reference lists.

Selection criteria

Randomized and quasi-randomized controlled trials comparing intrarectal quinine with intramuscular and intravenous quinine for treating people with uncomplicated and severe Plasmodium falciparum malaria.

Data collection and analysis

We independently assessed each trial's risk of bias quality and extracted data, including adverse event data. We analysed dichotomous data using the odds ratio and continuous data using the mean difference.

Main results

Ten randomized controlled trials, all involving children only (total of 1417 children), fulfilled the inclusion criteria. The same investigator was involved in nine of the trials. Seven trials compared proprietary intrarectal with intravenous quinine, and seven trials compared it with intramuscular treatment. We detected no statistically significant difference between intrarectal and intravenous or intramuscular routes for death, parasite clearance by 48 hours and seven days, parasite clearance time, fever clearance time, coma recovery time, duration of hospitalization, and time to drinking. The trials reporting on these outcomes were small, which resulted in large confidence intervals for all outcomes apart from duration of hospitalization. One large trial (898 children) reported that intrarectal was less painful than intramuscular administration.

Authors' conclusions

We detected no difference in the effect on parasites and clinical illness for intrarectal quinine, but most trials were small. Pain may be less with intrarectal proprietary, buffered quinine preparations (made less acidic by adjustment of the pH to 4.5). Further larger trials in patients with severe malaria and in adults are required before the intrarectal route can be recommended.

 

Plain language summary

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

Intrarectal quinine versus intravenous or intramuscular quinine for treating Plasmodium falciparum malaria

Quinine given through the rectum may be as effective as intravenous and intramuscular quinine for treating uncomplicated Plasmodium falciparum malaria. The data reviewed also lead to the conclusion that a diluted proprietary quinine solution (made less acidic by adjustment to a pH of 4.5) given intrarectally using a syringe for two to three days has less harmful effects compared with intramuscular quinine given for the same time period. Administration of intrarectal quinine (made less acidic by adjustment to a pH of 4.5) is significantly less painful than intramuscular injection of quinine. More trials are needed for patients with severe malaria and in adults.

 

摘要

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

背景

直腸、靜脈或肌肉注射給予奎寧在治療鎌狀瘧原蟲瘧疾(惡性瘧,Plasmodium falciparum malaria)的效果比較

對於患有惡性瘧(falciparum malaria)的兒童而言,直腸給予專利奎寧製劑(已將其酸度調降)比起與肌肉或靜脈注射給藥在使用上較為容易,且比較不痛。但直腸給藥的效果可能較差。

目標

比較由直腸、靜脈或肌肉給予奎寧在治療鎌狀瘧原蟲導致之瘧疾的效果

搜尋策略

我們在2008年5月搜尋了the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 2), MEDLINE, EMBASE, LILACS, 及 CINAHL. 我們也搜尋了研討會的會議紀錄,聯絡個別研究者及一間藥品公司,並檢視了參考文獻列表。

選擇標準

隨機及類似隨機的對照試驗中比較奎寧由直腸、肌肉或靜脈途徑治療單純且嚴重的鎌狀瘧原蟲瘧疾的病人。

資料收集與分析

我們獨立評估每一個試驗的品質偏差風險,並擷取數據,包括不良事件的資料。我們使用勝算比(odds ratio)來分析二元性資料(dichotomous data),使用平均差(mean difference)來分析連續性資料(continuous data)。

主要結論

符合標準的只有10個全是以兒童(總共1417個兒童)為對象的隨機對照試驗。其中同一位研究人員參與9個試驗。7個試驗比較了直腸與靜脈給予奎寧,9個試驗比較了直腸與肌肉注射。我們發現在死亡、48小時及7天之寄生蟲清除率、寄生蟲清除時間、發燒緩解時間、休克復原時間、住院持續期間以及恢復飲水時間上,直腸給藥與靜脈或肌肉途徑給藥並無統計上顯著差異。所有報告這些測量結果的試驗規模都很小,因此除了住院時間長短外,所有測量結果的信賴區間都很大。其中一個大型試驗(898個兒童)報告與肌肉注射比較下,直腸給藥比較不會感到疼痛。

作者結論

我們發現直腸給予奎寧對於寄生蟲及臨床疾病之療效上並未有差異,但大部分試驗的規模都很小。使用直腸內給予有專利酸性已緩衝的奎寧製劑(pH值調至4.5,酸性較小)造成的疼痛較少。但若想建議使用直腸途徑給藥,未來還需要針對嚴重瘧疾病人及成人進行較大型的試驗。

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

在治療單純鎌狀瘧原蟲瘧疾上奎寧經直腸給藥與靜脈及肌肉給藥同樣有效。回顧資料後也得到一個結論,即與同樣治療天數肌肉給予奎寧相較下,使用注射筒直腸給予稀釋過有專利的奎寧液(調整pH值為4.5,酸性較小)2 – 3天會有較少的疼痛。未來還需要更多對於嚴重瘧疾病人及成人的臨床試驗。

 

Laički sažetak

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

Kinin davan putem rektuma može biti jednako učinkovit kao kinin davan intravenski iintramuskularno za liječenje nekompliciranih oblika Plasmodium falciparum malarije.

Kinin davan putem rektuma može biti jednako učinkovit kao kinin davan intravenski i intramuskularnoza liječenje nekompliciranih oblika Plasmodium falciparum malarije. Podaci dobiveni Cochrane sustavnim pregledom također dovode do zaključka da je pravilno razrijeđena otopina kinina (smanjene kiselosti prilagodbom pH na 4.5) davana intrarektalno pomoću štrcaljke kroz dva do tri dana, imala manje štetne učinke u usporedbi s intramuskularnim davanjem kinina u istom vremenskom razdoblju. Intrarektalno davanje kinina (smanjene kiselosti zbog prilagodbe pH na 4.5) je značajno manje bolno od intramuskularno ubizganog kinina. Potrebno je provesti više studija kako bi se utvrdilovrijede li isti zaključci za pacijente s teškim malarijama i za odrasle osobe.

Bilješke prijevoda

Cochrane Hrvatska
Prevela: Ivana Miošić
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr