[e-med] Utilisation d'un KIt de quinine à la maison en traitement précoce du paldusime grave au Sénégal

Bonjour,

Ci joint le lien vers cette étude intéressante du Sénégal paru dans
Malaria Journal
Par JL Ndaye et al,

http://www.malariajournal.com/content/pdf/1475-2875-6-152.pdf
<http://www.malariajournal.com/content/pdf/1475-2875-6-152.pdf&gt;

Pilot feasibility study of an emergency paediatric kit for intra-rectal
quinine
administration used by the personnel of community-based health care units in
Senegal
Malaria Journal 2007, 6:152
Le résumé se trouve ci dessous

Cordialement

Hubert Barennes

Dr H.Barennes
hubert.barennes@auf.org <mailto:hubert.barennes%40auf.org>
Pédiatre, Epidémiologiste, PhD
Coordinateur enseignement et recherche
BP 9519 VIENTIANE, LAO PDR
tél (856.21).21.93.46
fax (856.21).21.93.47

Abstract

Background
Quinine injection is the reference treatment for malaria when oral
administration is impossible. Quinine can also be administered by the
intra-rectal route and, over the last ten years, a series of studies have
been conducted in children to determine the ideal dose and dilution in the
African situation. The aim of the present study was to evaluate the
feasibility and usefulness of a kit for an immediate administration of
quinine alkaloids (Quinimax®) by community health workers, prior to transfer
of the child to a more sophisticated health care establishment.

Methods
A prospective, open, descriptive community intervention study conducted in
northern Senegal at six village Health Units in children fewer than ten
years of age with non-peros malaria. Controls were given the routine care
prior to transfer to a Health Center, and cases were in addition
administered Quinimax® (20 mg/ml) via the intra-rectal route before
transfer. Patients were followed through complete cure and parasitological
tests were carried out on Days 0, 3 and 7.

Results
134 patients (79 cases/55 controls) were recruited between November 2003 and
May 2004 or October and November 2004. The two groups were comparable at
inclusion. In the case group, oral drugs could be administered after a mean
of 16.8 hours versus 33.6 hours in the control group. Time-to cure was
shorter in cases than in controls. Complete parasite clearance was obtained
in all patients by Day 7. The kit was well accepted by all concerned and
more than 80% of community health workers judged the kit easy to use.

Conclusion
The emergency paediatric kit is a useful tool in the management of malaria
in children who cannot be treated orally. It is feasible and easy to use for
health workers in community-based Health Units where, according to the WHO,
nearly 80% of malarial morbidity and mortality occurs.

Cette étude est très intéressante et confirme bien l'intérêt pour le
développement de formes intra-rectales pour le traitement du paludisme
pédiatrique sévère.

Par contre, le kit utilisé pourrait aisément être amélioré à partir de
formes galéniques plus adaptées, évitant les problèmes de préparation de la
formulation et surtout les pertes de principe actif sous forme liquide
rendant nécessaire l'administration d'une dose complémentaire suite à ces
rejets (possibilités de surdosage ou de sous dosage). Le coût du
développement aux normes européennes serait de l'ordre de 500 000 à 1
million d'Euros en fonction de la formulation choisie.

Pascal MILLET
pascal.millet@u-bordeaux2.fr

Merci pour l'information si intéressante qui allonge la liste des études effectuées sur la quinine par voie rectale.
Pour les lecteurs intéressés, il y a lieu de lire également l'article dont le lien est le suivant: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1904225&blobtype=pdf

Gabriel Bukasa Kaleka, B. Pharm., MPH.
+243 999301015
+243 999005024