Bonjour
Voici le résumé de cet article paru dans CID qui montre l'intérêt de la
voie rectale de quinine comparativement à la voie IV et peut intéresser
les praticiens utilisant encore la quinine pour le traitement du
paludisme grave.
Sur demande je peux vous adresser une copie de cet article.
Par ailleurs beaucoup d'information, sur ce sujet sont disponible sur le
blog http://barenneshubert.over-blog.com/
Nous serons heureux de recevoir vos commentaires
Cordialement
H. Barennes
*CID 2007:45 (1 December)*
Rectal versus Intravenous Quinine for the Treatment of Childhood
Cerebral Malaria in Kampala, Uganda:A Randomized, Double-Blind Clinical
Trial
*Jane Achan,**1 **Justus Byarugaba,**1 **Hubert Barennes,**2 **and James
K. Tumwine**1*
1Department of Pediatrics and Child Health, Makerere University,
Kampala, Uganda, and 2Institut Francophone De Medecine Tropicale,
Vientiane, Laos
*/Background. /*Although artemesinin derivatives are promising for the
treatment of severe /Plasmodium falciparum /malaria,
intravenous quinine remains the most affordable treatment. However,
administration of intravenous quinine is often not feasible
in rural areas in Africa because of the lack of simple equipment or
trained staff. We compared the efficacy and safety of intrarectal
quinine with those of intravenous quinine in the treatment of childhood
cerebral malaria.
*/Methods. /*In a randomized, double-blind clinical trial at Mulago
Hospital (Kampala, Uganda), Uganda’s national referral
hospital, we studied 110 children aged 6 months to 5 years who had
cerebral malaria. Patients were randomized to receive
either intrarectal or intravenous quinine. Main outcome measures
included parasite clearance time, fever clearance time, coma
recovery time, time to sit unsupported, time to begin oral intake, time
until oral quinine was tolerated, and death.
*/Results. /*Overall, there was no difference in the clinical and
parasitological outcomes between the 2 groups (data are
mean_standard deviation, intrarectal quinine group vs. intravenous
quinine group): coma recovery time, 19.4_18.1 h versus
17.0_12.1 h; fever clearance time, 26.7_16.1 h versus 29.9_18.1 h; and
parasite clearance time, 43.2_14.2 h versus
41.9_15.2 h. Mortality was similar in both groups; 4 of 56 patients in
the intrarectal quinine group died, and 5 of 54 patients
in the intravenous quinine group died (odds ratio, 1.3; 95% confidence
interval, 0.3–5.2). Intrarectal quinine was well tolerated,
and no major immediate adverse events occurred.
*/Conclusions. /*Intrarectal quinine is efficacious and could be used as
an alternative in the treatment of childhood cerebral
malaria, especially in situations in which intravenous therapy is not
feasible.