Dear all,
On behalf of Dr Heij (Medical Superintendent of St Francis Hospital
in Katete, Zambia), I would like to forward the following question to
you:
Opinions appear to differ on the optimal dose and most effective
route of administration of quinine in patients with cerebral malaria,
mostly children.
In St Francis Hospital, the i.v. route is used in these patients and
quinine is given continuously as a drip at a dose of 30mg/kg/24hours.
This protocol demands a great effort of the nursing staff, in putting
up the i.v.-lines and in supervising the continuation of the treatment.
In a recent paper in Postgraduate Doctor (vol 18, no 3, pp 60 - 65),
authors from Kilifi, Kenya advocate the use of i.m. quinine in
children with severe tropical malaria.
This has several advantages like saving nurses' time and the cost of
iv-fluids, but it is uncertain whether the therapeutic effect is
similar to the i.v. route.
We would be grateful to receive your comment on this controversy.
Regards,
Ron Wehrens, Pharmacist
Chairman Pharmaceutical Advisory Committee
Churches Medical Association of Zambia
-------------------------------------------
R.J.H. Wehrens
Tel./Fax: +260 1 262342, e-mail: rwehrens@zamnet.zm
Snailmail: P.O. Box 34693, Lusaka, Zambia
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rwehrens@zamnet.zm wrote:
Dear all,
On behalf of Dr Heij (Medical Superintendent of St Francis Hospital
in Katete, Zambia), I would like to forward the following question to
you:
Opinions appear to differ on the optimal dose and most effective
route of administration of quinine in patients with cerebral malaria,
mostly children.
In St Francis Hospital, the i.v. route is used in these patients and
quinine is given continuously as a drip at a dose of 30mg/kg/24hours.
This protocol demands a great effort of the nursing staff, in putting
up the i.v.-lines and in supervising the continuation of the treatment.
In a recent paper in Postgraduate Doctor (vol 18, no 3, pp 60 - 65),
authors from Kilifi, Kenya advocate the use of i.m. quinine in
children with severe tropical malaria.
This has several advantages like saving nurses' time and the cost of
iv-fluids, but it is uncertain whether the therapeutic effect is
similar to the i.v. route.
We would be grateful to receive your comment on this controversy.
Regards,
Ron Wehrens, Pharmacist
Chairman Pharmaceutical Advisory Committee
Churches Medical Association of Zambia
-------------------------------------------
R.J.H. Wehrens
Tel./Fax: +260 1 262342, e-mail: rwehrens@zamnet.zm
Snailmail: P.O. Box 34693, Lusaka, Zambia
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.
Intrmuscular Quinine.
IM quinine is widely used in the teaching hospital in Mombasa.No major
problems.The National Guidlines for Kenya is now recomending IM
qinine.The two large trials comparing quinine and artemether used IM
quinine(Hensbroek V,Onyiorah E et al. A Trial of Artemether or Quinine in
Children with Cerbral Malaria. N Engl J Med 1996;335:69-75)and in the
same issue of the N Engl J Med another trial was comparing IM quinine wit
h artemether in Vietnam.
TheWHO in its publication WHO MODEL PRESCRIBING INFORMATION series Drugs
Used in Parasitic Diseases (second edition)1995 mentions that IM quinine
can be used IM where facilities for intravenous infusion do not
exist.The dose is the same as the IV dose.
We decided to use IM quinine because it was easier,cheaper and much more
managable for the staff.We have had no changes in mortality after shift
to IM quinine.
Dr S K Sharif
P. O. Box 90233
Mombasa Kenya
e mail sksharif@Users.africaonline.co.ke
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