Intrarectal quinine versus intravenous or intramuscular quinine for treating <i>Plasmodium falciparum</i>
 malaria

Eisenhut, Michael; Omari, Aika Aa

doi:10.1002/14651858.cd004009.pub3

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Seven studies in African children that evaluated quinine administered with a loading dose by the IV or IM route were identified [ 10 - 16 ]. In addition, three studies identified by a Cochrane review but on African children not strictly having severe malaria were included [ 17 ]. These studies compared the effectiveness of quinine administered with a loading dose by the rectal (IR) and the IV route [ 18 , 19 ] and the IR and the IM route [ 20 ] (Table 5 ).…”

Section: Resultsmentioning

confidence: 99%

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

Musila

Opiyo

English

2011

Malar J

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BackgroundSevere malaria is a major contributor of deaths in African children up to five years of age. One valuable tool to support health workers in the management of diseases is clinical practice guidelines (CPGs) developed using robust methods. A critical assessment of the World Health Organization (WHO) and Kenyan paediatric malaria treatment guidelines with quinine was undertaken, with a focus on the quality of the evidence and transparency of the shift from evidence to recommendations.MethodsSystematic reviews of the literature were conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to appraise included studies. The findings were used to evaluate the WHO and Kenyan recommendations for the management of severe childhood malaria.ResultsThe WHO 2010 malaria guidance on severe malaria in children, which informed the Kenyan guidelines, only evaluated the evidence on one topic on paediatric care using the GRADE tool. Using the GRADE tool, this work explicitly demonstrated that despite the established use of quinine in the management of paediatric cases of severe malaria for decades, low or very low quality evidence of important outcomes, but not critical outcomes such as mortality, have informed national and international guidance on the paediatric quinine dosing, route of administration and adverse effects.ConclusionsDespite the foreseeable shift to artesunate as the primary drug for treatment of severe childhood malaria, the findings reported here reflect that the particulars of quinine therapeutics for the management of severe malaria in African children have historically been a neglected research priority. This work supports the application of the GRADE tool to make transparent recommendations and to inform advocacy efforts for a greater research focus in priority areas in paediatric care in Africa and other low-income settings.

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Section: Resultsmentioning

confidence: 99%

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

Musila

Opiyo

English

2011

Malar J

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“…Time to regain consciousness was 36-39 h [19]. A recent systematic review and metaanalysis however, concluded no significant difference in PCT, FCT, mortality rate, duration of hospitalization, and time-to-drinking between IR and IM administration [56], but not for the effect of dosage.…”

Section: Childrenmentioning

confidence: 94%

Clinical pharmacokinetics of quinine and its relationship with treatment outcomes in children, pregnant women, and elderly patients, with uncomplicated and complicated malaria: a systematic review

Saeheng

Na‐Bangchang

2022

Malar J

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Background Standard dosage regimens of quinine formulated for adult patients with uncomplicated and complicated malaria have been applied for clinical uses in children, pregnant women, and elderly. Since these populations have anatomical and physiological differences from adults, dosage regimens formulated for adults may not be appropriate. The study aimed to (i) review existing information on the pharmacokinetics of quinine in children, pregnant women, and elderly populations, (ii) identify factors that influence quinine pharmacokinetics, and (iii) analyse the relationship between the pharmacokinetics and treatment outcomes (therapeutic and safety) of various dosage regimens of quinine. Methods Web of Sciences, Cochrane Library, Scopus, and PubMed were the databases applied in this systematic search for relevant research articles published up to October 2020 using the predefined search terms. The retrieved articles were initially screened by titles and abstracts to exclude any irrelevant articles and were further evaluated based on full-texts, applying the predefined eligibility criteria. Excel spreadsheet (Microsoft, WA, USA) was used for data collection and management. Qualitative data are presented as numbers and percentages, and where appropriate, mean + SD or median (range) or range values. Results Twenty-eight articles fulfilled the eligibility criteria, 19 in children, 7 in pregnant women, and 2 in elderly (14 and 7 articles in complicated and uncomplicated malaria, respectively). Severity of infection, routes of administration, and nutritional status were shown to be the key factors impacting quinine pharmacokinetics in these vulnerable groups. Conclusions The recommended dosages for both uncomplicated and complicated malaria are, in general, adequate for elderly and children with uncomplicated malaria. Dose adjustment may be required in pregnant women with both uncomplicated and complicated malaria, and in children with complicated malaria. Pharmacokinetics studies relevant to clinical efficacy in these vulnerable groups of patients with large sample size and reassessment of MIC (minimum inhibitory concentration) should be considered.

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“…Antimalarial drugs can be administered in a number of ways: oral (amodiaquine), intramuscular (artemether), intravenous (artesunate) [ 143 ]. There is also a scope for rectal administration of the antimalarial drug (quinine) [ 144 ].…”

Section: Application Of Thermosensitive Liquid Suppositories As Innovative Systems For Delivering Various Drugsmentioning

confidence: 99%

Achievements in Thermosensitive Gelling Systems for Rectal Administration

Bialik

Kuras

Sobczak

et al. 2021

IJMS

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Rectal drug delivery is an effective alternative to oral and parenteral treatments. This route allows for both local and systemic drug therapy. Traditional rectal dosage formulations have historically been used for localised treatments, including laxatives, hemorrhoid therapy and antipyretics. However, this form of drug dosage often feels alien and uncomfortable to a patient, encouraging refusal. The limitations of conventional solid suppositories can be overcome by creating a thermosensitive liquid suppository. Unfortunately, there are currently only a few studies describing their use in therapy. However, recent trends indicate an increase in the development of this modern therapeutic system. This review introduces a novel rectal drug delivery system with the goal of summarising recent developments in thermosensitive liquid suppositories for analgesic, anticancer, antiemetic, antihypertensive, psychiatric, antiallergic, anaesthetic, antimalarial drugs and insulin. The report also presents the impact of various types of components and their concentration on the properties of this rectal dosage form. Further research into such formulations is certainly needed in order to meet the high demand for modern, efficient rectal gelling systems. Continued research and development in this field would undoubtedly further reveal the hidden potential of rectal drug delivery systems.

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

Cited by 5 publications

References 26 publications

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

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

Clinical pharmacokinetics of quinine and its relationship with treatment outcomes in children, pregnant women, and elderly patients, with uncomplicated and complicated malaria: a systematic review

Achievements in Thermosensitive Gelling Systems for Rectal Administration

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