Quinine-tetracycline for multidrug resistant falciparum malaria.
ABSTRACT Plasmodium falciparum in Southeast Asia is highly resistant to chloroquine and sulfadoxine/ pyrimethamine. Quinine-tetracycline has been used as a second line treatment for uncomplicated falciparum malaria, but duration of treatment varies from place to place. The 7-days course of this combination has been shown to be very effective. However, due to the cinchonism adverse effects, the patient compliance has not been satisfactory. We have evaluated the efficacy of a 7-days course of tetracycline in combination with either 5 or 7-days course of quinine. Ninety male Thai patients who were admitted to the Bangkok Hospital for Tropical Diseases were randomized to receive tetracycline 250 mg qid for 7 days in combination with either quinine 600 mg tid for 5 days (Q5T7; group A) or quinine 600 mg tid for 7 days (Q7T7; group B). The patients were hospitalized for 28 days. Patients in both groups had a comparable initial response to treatment, with the clearance of fever and parasites within 4 days. There were 46 and 40 patients in group A and B, respectively, who completed the 28 day of follow-up. The cure rates were 87 and 100%, respectively for group A and B. No serious adverse effects were found in either group; transient nausea, vomiting and tinnitus were common findings. The incidence of adverse effects was not different between the two groups. The results from the present study suggest that a short course treatment of quinine (Q5T7) had significantly decreased the cure rate. In areas with quinine resistant falciparum malaria, a full course of 7-days quinine, in combination with 7-days course of tetracycline is recommended for hospital treatment. However, an alternative shorter course of antimalarials is suggested for home treatment.
SourceAvailable from: Muheet SaifiAfrican journal of pharmacy and pharmacology 02/2013; 7(5):148-156. DOI:10.5897/AJPPX12.015 · 0.84 Impact Factor
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ABSTRACT: The treatment of falciparum malaria poses unique challenges in settings where malaria transmission intensity is high because recurrent infections are common. These could be new infections, recrudescences, or a combination of the two. Though several African countries continue to use quinine as the second line treatment for patients with recurrent infections, there is little information on its efficacy when used for rescue therapy. Moreover, such practice goes against the World Health Organisation (WHO) recommendation to use combination therapy for uncomplicated malaria. We conducted a nested, randomized, open label, three-arm clinical trial of rescue therapy in children 6-59 months old with recurrent malaria infection during 28 days post treatment with artemisinin combination treatment (ACT). Patients were randomly assigned to receive either quinine, artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHAPQ), and actively followed up for 28 days. Among 220 patients enrolled, 217 (98(.)6 %) were assigned an efficacy outcome and 218 (99(.)1 %) were assessed for safety. The risk of recurrent infection was significantly higher in patients treated with quinine (70 %, 74/110, HR = 3(.)9; 95 % CI: 2(.)4-6(.)7, p<0(.)0001) and AL (60%, 21/35, HR = 3(.)3; 95 % CI: 1(.)8-6(.)3, p<0(.)0002), compared to DHAPQ (25%, 18/72). Recrudescence tended to be lower in the DHAPQ (1%, 1/72) than in the quinine (7%, 8/110) or AL (6 %, 2/35) group, though it was not statistically significant. No serious adverse events were reported. Recurrent infections observed after the administration of an ACT can be successfully treated with an alternative ACT rather than with quinine. Current Controlled Trials ISRCTN99046537.PLoS ONE 01/2013; 8(1):e53772. DOI:10.1371/journal.pone.0053772 · 3.53 Impact Factor
Article: Drugs for malaria[Show abstract] [Hide abstract]
ABSTRACT: Malaria remains one of the most common causes of illness and death in developing countries. Malaria generally has been treated with quinoline-containing antimalarials (chloroquine, quinine, mefloquine, primaquine, amodiaquine) or antifolates (sulfadoxine, pyrimethamine, proguanil). Newer drugs include the artemisinin derivatives and atovaquone. The selection of antimalarials for a given case of malaria is based on (1) the species of Plasmodium involved, (2) the severity of the illness, and (3) the geographic origin of the infection. Antimalarials also are used prophylactically, but generally only by visitors to endemic regions. Chloroquine-resistant strains of malaria now are found throughout the world; multidrug-resistant malaria is now common in Southeast Asia. Drug-resistant malaria is becoming an increasingly important public health problem. Copyright © 2000 by W.B. Saunders CompanySeminars in Pediatric Infections Diseases 07/2000; 11(3):202–212. DOI:10.1053/pi.2000.6232