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High first dose quinine regimen for treating severe malaria.
1Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria. a.lesi@alpha.linkserve.com
The Cochrane Database of Systematic Reviews
|July 26, 2002
Summary
A high initial dose of quinine for severe malaria may speed parasite and fever clearance. However, data are insufficient to confirm if this loading dose reduces death or convulsion risk.
Area of Science:
- Clinical Medicine
- Pharmacology
- Infectious Diseases
Background:
- Quinine is a primary treatment for severe malaria.
- The optimal dosing strategy, specifically the use of an initial high dose (loading dose), is debated.
Purpose of the Study:
- To evaluate clinical outcomes and adverse events associated with a quinine loading dose regimen versus a uniform dose regimen in severe malaria patients.
Main Methods:
- Systematic review of randomized controlled trials.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE, and LILACS.
- Data analysis included relative risk and weighted mean difference; study authors were contacted for additional information.
Main Results:
- A meta-analysis of 72 participants from three trials was conducted.
- The quinine loading dose showed a trend towards fewer deaths (not statistically significant).
- Associated with faster parasite and fever clearance, but also increased transient hearing loss.
Conclusions:
- Quinine loading dose significantly reduces fever and parasite clearance times.
- Insufficient evidence exists to definitively conclude on the impact of loading dose on mortality or convulsions.