High first dose quinine regimen for treating severe malaria (Cochrane Review)

A substantive amendment to this systematic review was last made on 22 April 2002. Cochrane reviews are regularly checked and updated if necessary.

Background: Quinine is used for treating severe malaria. There are arguments for giving an initial high dose. We examined the evidence for and against this policy.

Objectives: To assess clinical outcomes and adverse events of a high first (loading) dose regimen of quinine with a uniform (no loading) dose regimen in people with severe malaria.

Search strategy: We searched the Cochrane Infectious Diseases Group specialized trials register (May 2002), The Cochrane Controlled Trials Register (Issue 2, 2002), MEDLINE (1966 to April 2002), EMBASE (1988 to March 2002), LILACS (www.bireme.br; accessed February 2002), and conference proceedings for relevant abstracts. We also contacted researchers working in the field and checked the reference lists of all studies.

Selection criteria: Randomized controlled trials.

Data collection and analysis: Two reviewers independently assessed the methodological quality of the trials and extracted data. Review Manager (Version 4.1) was used to analyse the data: Relative Risk for binary data and weighted mean difference (WMD) for continuous data. Study authors were contacted for additional information.

Main results: Three small trials, with two contributing to a meta-analysis of 72 participants. Loading dose was associated with fewer deaths, but this was not statistically significant (RR 0.43; 95% confidence interval (CI) 0.09 to 2.15). Loading dose was associated with faster clearance of parasites (WMD 7.44; 95% CI 1.64 to 13.24 hours), resolution of fever (WMD 11.11; 95% CI 2.18 to 20.04 hours), and transient hearing loss (RR 3.14; 95% CI 1.05 to 9.38). No significant difference was detected for recovery of consciousness, neurological sequelae, or convulsions, but the numbers were small.

Reviewers' conclusions: Quinine loading dose reduced fever clearance time and parasite clearance time. Data are insufficient to confirm or refute whether a loading dose reduced the risk of death or convulsions.

Citation: Lesi A, Meremikwu M. High first dose quinine regimen for treating severe malaria (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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