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Pharmacokinetics of quinine in children
Insights
This study determined optimal quinine dihydrochloride dosing for severe malaria in children. Recommended intravenous loading and maintenance doses aim for therapeutic serum concentrations, with oral quinine sulphate for recovery.
Area of Science:
- Pharmacology
- Pediatric Medicine
- Infectious Diseases
Background:
- Severe malaria in children requires effective antimalarial treatment.
- Quinine is a primary treatment for severe malaria, but optimal dosing in pediatric populations requires further elucidation.
- Understanding quinine pharmacokinetics is crucial for achieving therapeutic serum concentrations and improving patient outcomes.
Purpose of the Study:
- To evaluate serum quinine concentrations in children following different administration routes (intravenous, intramuscular, nasogastric).
- To determine key pharmacokinetic parameters, including half-life and volume of distribution.
- To establish evidence-based dosing recommendations for quinine dihydrochloride in pediatric severe malaria.
Main Methods:
- Serum quinine concentrations were measured in pediatric patients after intravenous infusion, intramuscular injection, and nasogastric administration of quinine dihydrochloride.
- Pharmacokinetic parameters, specifically half-life and volume of distribution, were calculated.
- Dosing regimens were analyzed to achieve target serum quinine levels of 10 microgram/ml.
Main Results:
- The mean half-life of quinine was 11.1 +/- 4.8 hours, and the volume of distribution was 1.39 +/- 0.37 L/kg.
- Quinine demonstrated rapid and complete absorption via intramuscular and nasogastric routes.
- Individual serum concentration variability necessitates monitoring.
Conclusions:
- A parenteral loading dose of 20 mg/kg quinine dihydrochloride followed by 7.5 mg/kg every 8 hours is suggested for severe pediatric malaria to reach target serum levels.
- Oral quinine sulphate (10 mg/kg every 8 hours) is recommended during recovery.
- Therapeutic drug monitoring of serum quinine concentrations is advised due to inter-individual variability.
Abstract:
Serum quinine concentrations were measured in seven children after intravenous infusion of quinine dihydrochloride, in eight children after intramuscular injection of quinine dihydrochloride, and in six children after nasogastric administration of a solution of quinine dihydrochloride. The mean (+/- SD) half-life of quinine was 11.1 +/- 4.8 hours, and the volume of distribution was 1.39 +/- 0.37 L/kg. To attain a serum level of 10 microgram/ml quinine, we suggest that children with severe malaria be given a loading dose of 20 mg/kg quinine dihydrochloride parenterally, followed by 7.5 mg/kg every 8 hours. Once recovery begins, quinine sulphate 10 mg/kg may be given orally every 8 hours. Serum concentrations should be monitored, if possible, because they vary greatly from person to person. Quinine is rapidly and completely absorbed after either intramuscular or nasogastric administration.