Low-dose quinine is effective in the treatment of chloroquine-resistant<i>Plasmodium falciparum</i>malaria in eastern Sudan

Ibrahim, M.H.; Elbashir, Mustafa I.; Naser, Angelo Ali; Aelbasit, I A; Kheir, Musa M.; Adam, Ishag

doi:10.1179/000349804225003488

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Piperaquine as the partner drug which has a long elimination half-life (≈ 28 days) will clear the remaining parasites and could also provide post treatment prophylactic effect [27, 28]. The 28 days cure rate of supervised 7 days quinine in multidrug resistant malaria area in Thailand was 87% and in Sudan was 93.7% [29, 30]. The main challenge is ensuring compliance of 3 times a day for 7 days quinine in a non-research environment [3, 22].…”

Section: Discussionmentioning

confidence: 99%

Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: lesson learnt from a field hospital in Timika, Papua, Indonesia

Sikora

Poespoprodjo

Kenangalem³

et al. 2019

Malar J

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BackgroundIntravenous artesunate and its follow on full course dihydroartemisinin–piperaquine are the standard treatment for severe malaria in Indonesia. The current policy suggests that intravenous and oral quinine could be used when standard therapy is not available. Its pragmatic use of both treatment combinations in a field hospital is evaluated.MethodsA retrospective study among hospitalized malaria patients receiving intravenous anti-malarial treatments at Mitra Masyarakat Hospital, Timika from April 2004 to December 2013 was conducted. The length of hospital stay (LoS) and the risk of malaria recurrence within 28 days after hospital admission were compared between patients receiving intravenous artesunate and oral dihydroartemisinin–piperaquine (Iv Art + DHP) and those receiving intravenous and oral quinine (Iv + Oral Qu).ResultsOf 10,514 patients requiring intravenous therapy, 2759 received Iv + Oral Qu and 7755 received Iv Art + DHP. Plasmodium falciparum infection accounted for 65.8% (6915), while Plasmodium vivax, Mixed infections, Plasmodium malariae and Plasmodium ovale were accounted for 17.0% (1789), 16.4% (1729), 0.8% (79) and 0.01% (2) of the infections, respectively. The majority of severe malaria hospital admissions were highland Papuans (78.0%, 8201/10,501). In total 49% (5158) of patients were older than 15 years and 3463 (32.9%) were children under 5 years old. The median LoS was shorter in patients receiving intravenous artesunate compared to those treated with intravenous quinine (median = 2 [IQR 1–3] versus 3 days [IQR 2–4], p < 0.0001). Patients treated with intravenous quinine had higher risk of being hospitalized longer than 2 days (aOR of 1.70 [95% CI 1.54–1.88], p < 0.0001). The risk of recurrences within 28 days after hospital admission was 1.94 times higher (95% CI aHR 1.57–2.39, p < 0.0001) in patients receiving intravenous quinine with follow on oral quinine treatment than in patients treated with DHP after intravenous artesunate therapy.ConclusionsIntravenous artesunate reduced the LoS of malaria patients and in combination with DHP reduced the risk of malaria recurrence within 28 days after hospital admission compared to those with Iv + Oral Qu treatment. Thus, ensuring continuous supply of intravenous artesunate and artemisinin-based combination therapy (ACT) should be a priority.

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Section: Discussionmentioning

confidence: 99%

Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: lesson learnt from a field hospital in Timika, Papua, Indonesia

Sikora

Poespoprodjo

Kenangalem³

et al. 2019

Malar J

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“…The treatment regimen currently recommended in sub-Saharan Africa is 10 mg/kg of the base given 8 hourly for 7 days. This regimen was associated with a lower rate of recurrent infections on day 28 (6.3%) compared to the 10 mg/kg twice daily regimen (16.1%)[44]. …”

Section: Quinine For Uncomplicated Malariamentioning

confidence: 99%

Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Achan

Talisuna

Erhart

et al. 2011

Malar J

791

466

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Quinine remains an important anti-malarial drug almost 400 years after its effectiveness was first documented. However, its continued use is challenged by its poor tolerability, poor compliance with complex dosing regimens, and the availability of more efficacious anti-malarial drugs. This article reviews the historical role of quinine, considers its current usage and provides insight into its appropriate future use in the treatment of malaria. In light of recent research findings intravenous artesunate should be the first-line drug for severe malaria, with quinine as an alternative. The role of rectal quinine as pre-referral treatment for severe malaria has not been fully explored, but it remains a promising intervention. In pregnancy, quinine continues to play a critical role in the management of malaria, especially in the first trimester, and it will remain a mainstay of treatment until safer alternatives become available. For uncomplicated malaria, artemisinin-based combination therapy (ACT) offers a better option than quinine though the difficulty of maintaining a steady supply of ACT in resource-limited settings renders the rapid withdrawal of quinine for uncomplicated malaria cases risky. The best approach would be to identify solutions to ACT stock-outs, maintain quinine in case of ACT stock-outs, and evaluate strategies for improving quinine treatment outcomes by combining it with antibiotics. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance.

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“…In the present study, 9.3% of the patients with uncomplicated P. falciparum malaria who were treated with quinine under close medical supervision showed late treatment failure. In other recent studies in eastern Sudan, sporadic quinine failures have apparently been observed among pregnant women and children with severe P. falciparum malaria (Adam et al, 2002 and in other patients with the uncomplicated disease (Ibrahim et al, 2004). In these studies, however, neither the quinine concentrations in the blood of the patients nor the in-vitro susceptibility to quinine of the apparently quinine-resistant parasites were determined, and there was no parasite genotyping to differentiate between reinfection and true recrudescence.…”

Section: Discussionmentioning

confidence: 95%

Efficacies of chloroquine, sulfadoxine–pyrimethamine and quinine in the treatment of uncomplicated,Plasmodium falciparummalaria in eastern Sudan

Adam¹,

Osman²,

Elghzali³

et al. 2004

Annals of Tropical Medicine & Parasitology

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The efficacies of several antimalarial drugs in the treatment of uncomplicated Plasmodium falciparum malaria were compared, during an open, randomized trial, in New Halfa, eastern Sudan. The 96 patients who completed the 28 days of follow-up were treated with chloroquine (N = 26), sulfadoxine-pyrimethamine (N = 38) or quinine (N = 32). No treatment failures were observed among the patients given sulfadoxine-pyrimethamine. Only 23.1% of the patients given chloroquine showed adequate clinical response, however, the rest showing early (15.4%) or, more frequently, late (61.5%) treatment failure. In terms of parasitological failure, 54.1% of the patients given chloroquine showed early RI resistance, 7.7% showed late RI, and 15.1% showed RIII. Most (90.6%) of the patients treated with quinine had adequate treatment responses, the rest having late treatment failures (and late RI). The frequency of treatment failure was significantly higher, however, among the patients given chloroquine than in the quinine-treatment arm. The present results and those of earlier investigations indicate that the problem of chloroquine resistance is worsening in eastern Sudan, and that the use of chloroquine as the first-line drug for the treatment of uncomplicated malaria in this area is now compromised. The response to quinine may also be faltering.

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Low-dose quinine is effective in the treatment of chloroquine-resistantPlasmodium falciparummalaria in eastern Sudan

Cited by 8 publications

References 14 publications

Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: lesson learnt from a field hospital in Timika, Papua, Indonesia

Intravenous artesunate plus oral dihydroartemisinin–piperaquine or intravenous quinine plus oral quinine for optimum treatment of severe malaria: lesson learnt from a field hospital in Timika, Papua, Indonesia

Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Efficacies of chloroquine, sulfadoxine–pyrimethamine and quinine in the treatment of uncomplicated,Plasmodium falciparummalaria in eastern Sudan

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