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High first dose quinine regimen for treating severe malaria
1Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.
The Cochrane Database of Systematic Reviews
|July 22, 2004
Summary
A high initial dose of quinine (loading dose) for severe malaria speeds up parasite and fever clearance. However, current evidence is insufficient to prove it reduces the risk of death.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Severe malaria treatment relies on quinine.
- The use of an initial high dose (loading dose) of quinine is debated.
- This study evaluates the evidence for and against quinine loading doses.
Purpose of the Study:
- To compare clinical outcomes and adverse events of quinine loading dose versus uniform dose regimens.
- To assess the efficacy of high-dose quinine in severe malaria patients.
Main Methods:
- Systematic review of randomized controlled trials.
- Searched multiple databases including Cochrane, MEDLINE, EMBASE, and LILACS.
- Independent data extraction and analysis using Review Manager software.
Main Results:
- Four trials (n=144) were included.
- Quinine loading dose showed faster parasite and fever clearance times.
- No statistically significant reduction in mortality was observed, though numbers were small.
Conclusions:
- Quinine loading dose improves key indicators like fever and parasite clearance.
- More data is needed to confirm the impact of loading dose on mortality in severe malaria.
- The policy of using a quinine loading dose requires further investigation.