High efficacy of short-term quinine-antibiotic combinations for treating adult malaria patients in an area in which malaria is hyperendemic. Antimicrob Agents Chemother

International Research Laboratory, Albert-Schweitzer-Hospital, Lambaréné, Gabon.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.48). 02/1995; 39(1):245-6. DOI: 10.1128/AAC.39.1.245
Source: PubMed


In a randomized trial, a three-dose quinine monotherapy was compared with short-term combination regimens of quinine-clindamycin
and quinine-doxycycline for treating adult Gabonese patients with Plasmodium falciparum malaria. In quinine-treated patients,
only 38% were ultimately cured. In contrast, more than 90% of patients were cured after treatment with either combination

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    • "There was no difference in the risk of treatment failure between clindamycin plus quinine compared with quinine by day 28 in the one trial [39] with adequate allocation concealment (RR 0.20, 95% CI 0.01 to 4.15; 115 participants). However, in the three trials [34,35,37] with unclear allocation concealment, treatment with clindamycin plus quinine significantly reduced the risk of treatment failure (RR 0.14, 95% CI 0.07 to 0.29; 291 participants). Figure 4 is a summary of the effect of allocation concealment on treatment efficacy. "
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    ABSTRACT: Artemisinin-based combinations are recommended for treatment of uncomplicated falciparum malaria, but are costly and in limited supply. Clindamycin plus quinine is an alternative non-artemisinin-based combination recommended by World Health Organization. The efficacy and safety of clindamycin plus quinine is not known. This systematic review aims to assess the efficacy of clindamycin plus quinine versus other anti-malarial drugs in the treatment of uncomplicated falciparum malaria. All randomized controlled trials comparing clindamycin plus quinine with other anti-malarial drugs in treating uncomplicated malaria were included in this systematic review. Databases searched included: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS. Two authors independently assessed study eligibility, extracted data and assessed methodological quality. The primary outcome measure was treatment failure by day 28. Dichotomous data was compared using risk ratio (RR), in a fixed effects model. Seven trials with 929 participants were included. Clindamycin plus quinine significantly reduced the risk of day 28 treatment failure compared with quinine (RR 0.14 [95% CI 0.07 to 0.29]), quinine plus sulphadoxine-pyrimethamine (RR 0.17 [95% CI 0.06 to 0.44]), amodiaquine (RR 0.11 [95% CI 0.04 to 0.27]), or chloroquine (RR 0.11 [95% CI 0.04 to 0.29]), but had similar efficacy compared with quinine plus tetracycline (RR 0.33 [95% CI 0.01 to 8.04]), quinine plus doxycycline (RR 1.00 [95% CI 0.21 to 4.66]), artesunate plus clindamycin (RR 0.57 [95% CI 0.26 to 1.24]), or chloroquine plus clindamycin (RR 0.38 [95% CI 0.13 to 1.10]). Adverse events were similar across treatment groups but were poorly reported. The evidence on the efficacy of clindamycin plus quinine as an alternative treatment for uncomplicated malaria is inconclusive. Adequately powered trials are urgently required to compare this combination with artemisinin-based combinations.
    Full-text · Article · Jan 2012 · Malaria Journal
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    • "However, non-compliance to quinine greatly increased with increasing days on therapy to about 44% by day 7[45]. Promotion of shorter courses of quinine, especially in combination with antibiotics, should improve compliance as well as treatment outcomes [39,109]. "
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    ABSTRACT: Quinine remains an important anti-malarial drug almost 400 years after its effectiveness was first documented. However, its continued use is challenged by its poor tolerability, poor compliance with complex dosing regimens, and the availability of more efficacious anti-malarial drugs. This article reviews the historical role of quinine, considers its current usage and provides insight into its appropriate future use in the treatment of malaria. In light of recent research findings intravenous artesunate should be the first-line drug for severe malaria, with quinine as an alternative. The role of rectal quinine as pre-referral treatment for severe malaria has not been fully explored, but it remains a promising intervention. In pregnancy, quinine continues to play a critical role in the management of malaria, especially in the first trimester, and it will remain a mainstay of treatment until safer alternatives become available. For uncomplicated malaria, artemisinin-based combination therapy (ACT) offers a better option than quinine though the difficulty of maintaining a steady supply of ACT in resource-limited settings renders the rapid withdrawal of quinine for uncomplicated malaria cases risky. The best approach would be to identify solutions to ACT stock-outs, maintain quinine in case of ACT stock-outs, and evaluate strategies for improving quinine treatment outcomes by combining it with antibiotics. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance.
    Full-text · Article · May 2011 · Malaria Journal
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    • "The World Health Organization and the Centres for Disease Control and Prevention, Atlanta, recommend mefloquine for drug-prophylaxis to non-immune travellers to Central and West Africa (OMS 1997). Quinine is still successfully used in severe malaria (Kremsner et al. 1995), but is not recommended to treat mild malaria (Metzger et al. 1995). The efficiency of halofantrine and mefloquine against P. falciparum begins to be greatly compromised in some parts of the world (Reacher et al. 1980; Brasseur et al. 1992, 1993). "
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    ABSTRACT: To determine the in vitro activity of antimalarial drugs against isolates of Plasmodium falciparum in Gabon. Plasmodium falciparum isolates were collected from symptomatic infections in the hospitals of Bakoumba and Franceville, south-east Gabon and in 2000. In vitro activity of chloroquine, quinine, mefloquine, halofantrine was measured by the isotopic microtest. A total of 60 and 62 isolates gave interpretable data in Franceville and Bakoumba, respectively. In Franceville, 50.0% (mean IC50 = 111.7 nm), 0% (mean IC50 = 156.7 nm), and 21.2% (mean IC50 = 12.4 nm) of isolates, respectively, showed in vitro resistance to chloroquine, quinine and mefloquine. In Bakoumba, we saw resistance to chloroquine, quinine, mefloquine and halofantrine in 95.0% (mean IC50 = 325.8 nm), 10.2% (mean IC50 = 385.5 nm), 47.5% (mean IC50 = 24.5 nm) and 18.2% (mean IC50 = 1.9 nm) of isolates, respectively. Activities of chloroquine and mefloquine, chloroquine and quinine, and mefloquine and quinine were positively correlated. Antimalarial drug resistance is high in this area of Gabon. The extent of resistance is disparate, as all tested drugs were less efficacious in Bakoumba than in Franceville.
    Preview · Article · Feb 2003 · Tropical Medicine & International Health
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