Low Dose Quinine For Treatment of Chloroquine Resistant Falciparum Malaria

Abstract

The current recommended dose of 10mg quinine/kg body weight 3 times a day for 7 days for treatment of chloroquine resistant falciparum malaria is so high that many patients may suffer cinchonism. In order to identify the lowest effective dose of quinine for treatment of chloroquine resistant malaria, we enrolled ninety three patients who presented to the health centre at Elhara Eloula, New halfa, Eastern Sudan with symptoms of malaria after completing the full dose of chloroquine. The patients were randomized in three treatment groups for quinine treatment. They received quinine for 7 days as follow: 10mg/kg thrice daily (group I, 32 patients), 10mg/kg twice daily (group 2,31 patients) and 15mg/kg once daily (group 3,30 patients). All patients were followed daily for 7 days and then weekly for 3 weeks. There was no significant differnce in parasite clearance time between the three groups. Parasitaemia was detected during the follow- up on day 28 or earlier in 2/32(6.3%), 5/31(16.1%) and 5/30(16.7%) in the three groups, respectively; this differnce was not significant. In 75% of these patients the parasitaemia was due to true recrudescence, as confirmed by parasite genotyping . Thus, the data in this study showed that low dose of quinine can be prescribed to treat chloroquine resistant falciparum malaria in Sudan with comparable outcome to high quinine dose.