In previous studies parasites survived
exposure to extremely high quinine concentrations in vitro for 96 hours,
whereas no live parasites were seen following 168 hours of exposure to low
concentrations, indicating that the periode of treatment is very important. In
Guinea-Bissau the clinical respons to 7.5 mg/kg and 10 mg/kg twice a day for 7
days were equally efficient. The present study compared 15 mg/kg (group I) and
7.5 mg/kg (group II) twice a day with one daily dose of 15 mg/kg (group III)
for treatment of P.falciparum malaria in children in Guinea-Bissau in order to
simplify the treatment schedule.
Methods: Children with symptoms
compatible with malaria were randomised to one of the three study groups if a
malaria film showed monoinfection with P.falciparum of 20 or more parasites per
200 leukocytes. The children were seen weekly until day 35. Their conditions
were evaluated and a malaria film examined.
Results: 100 children were included in
each study-group. The cumulative percentages of children with reappearing
parasitaemia during follow-up were (in brackets the number of children with
positive malaria films divided by the total number of children examined):
group day7
day14 day21 day28 day35
I 0(0/87)
0(0/83) 6(5/79) 12(4/71) 17(4/65)
II 0(0/88)
0(0/85) 9(8/84) 15(4/69) 19(3/63)
III 0(0/92) 2(2/86) 5(2/83) 9(3/77) 13(3/70)
There were no statistically significant
differences in the rates between the groups. On day 0 there were no differences
in the symptoms reported for the past 12 hours. On day one 1% in groupII
vomited as compared to 9% (groupI) and 13% (groupIII). No other differences in
symptoms were reported.
Conclusion: The present study indicates
that the quinine treatment schedule can be simplified by reducing the number of
daily doses from the 3 recommended by WHO to one only. The higher level of
vomiting associated with the higher doses of quinine during the initial 24
hours of treatment might be avoided by dividing the first dose into 2 doses of
7.5 mg/kg.