Makindo Medical Notes.com

Suspected falciparum malaria needs Oral or IV Quinine followed by Doxycycline or Fansidar or equivalent. Never give by rapid IV injection, as lethal hypotension may result

About: Always check the BNF link here

• Alkaloid from the bark of the South American tree Cinchona
• The original and still effective drug to treat falciparum malaria

Mode of action

• Active against asexual stages of plasmodium
• Inactive against exoerythrocytic stages of infection with Ovale/Vivax
• Some resistance now beginning to develop

Indications

• Falciparum malaria, Nocturnal leg cramps
• Is not indicated as malarial prophylaxis

Indications/Dose (Check wth BNF)

• Falciparum malaria can take oral medications: Quinine 600 mg TDS for 7 days.
• Reduced GCS/Severe Falciparum malaria: Quinine 20 mg/kg slow IV over 4 h (max 1.4 g). Maintenance (8 h later): Quinine 10 mg/kg (max 700 mg) PO/slow IV over 4 h TDS. Dilute to 500 ml with NS/G5 by controlled IV infusion. If IV not possible then consider IM to the anterior thigh.
• Uncomplicated falciparum malaria: Quinine 600 mg/8 h PO for 7 days plus DOXYCYCLINE 200 mg OD (or CLINDAMYCIN 450 mg TDS for pregnant women) for 7 days OR ATOVAQUONE PROGUANIL (Malarone): 4 'standard' tablets daily for 3 days OR CO-ARTEM (Riamet): if weight >35 kg, 4 tablets then 4 tablets at 8, 24, 36, 48 and 60 h.

Contraindications

• Optic neuritis, Caution with G6PDH deficiency

Cautions

• Hypoglycaemia - notable with treatment IV for falciparum infection
• Arrhythmias when given IV - needs ECG monitoring

Side-effects (Cinchonism)

• Tinnitus and Impaired hearing, Nausea and Vomiting, Altered vision
• Hypoglycaemia - notable with treatment IV for falciparum infection
• Arrhythmias when given IV - needs ECG monitoring