S.K.
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.
We do it as 600mg in 200 ml D5W over 4 hours every 8 hours (which translates
to 30mg/kg/24h). I got two patients on this at this very moment. Sticking
the drip is a once only affair as it is kept open with D5W or 1/2NSD5 with
additional glucose added. Supervising of the treatment is not much work.
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.
I don't like it. (I have passed this on to the man, and will report back)
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.
IV fluids are more for the (re)hydration and quinine is hypoglycemic
so you'd need them anyway.
I refuse to accept that the saving in nurses' time outweighs the
dangers.
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.
Exactly, "where facilities do not exist".
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.
greetings, el
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