Quinine can be given by the oral, intravenous or intramuscular routes.
Quinine should be given orally for the treatment of uncomplicated multidrug- resistant falciparum malaria and to complete the treatment of patients with severe or complicated malaria who are initially treated parenterally. If part or all of a dose is vomited within 1 hour, the same amount must be re-administered immediately. It is administered parenterally to patients with severe or complicated malaria who cannot take drugs orally because of coma, convulsions or vomiting.
QINARSOL Tablets
Should be taken with food or after meals.
Adults
600 mg (two tablets) every 8 hours for 3–7 days.
Children
10 mg/kg body weight every 8 hours for 3–7 days.
QINARSOL Injection
Intravenous Use
Adults
In adult patients, a loading dose is probably advisable to allow quinine concentrations to enter the therapeutic range more rapidly. Intravenous quinine should be given by rate-controlled infusion (never by bolus injection). Where there are intensive care facilities, the dihydrochloride quinine salt may be given in an initial loading dose of 7 mg.kg -1 (body weight) over 30 minutes via an infusion pump, immediately followed by 10 mg.kg -1 over 4 hours (i.e., at a total dose of 17.5 mg.kg -1 over 4.5 hours). Where this is not possible, the loading dose should comprise 20 mg.kg -1 infused over 4 hours. Neither of these regimens appears to cause significant toxicity. Patients who have received quinine or mefloquine (which resembles quinine structurally) before the start of in-patient treatment should not be given the loading dose.
Maintenance doses of quinine should be 10 mg.kg -1 , given at 8-hour intervals, infused over 2 hours. Some physicians prefer to use a continuous infusion. If there is no clinical improvement in the patient, and intravenous quinine is still being given on the third day, doses should be reduced by one-third. All patients on quinine are at risk of developing quinine-induced hypoglycaemia, and 10% glucose infusions may be needed in refractory cases; hence, blood glucose should be measured frequently.
Children
Children with cerebral malaria sustain higher plasma quinine concentrations than adults given the same dose (weight adjusted) because of their smaller volume of distribution. In an intensive care setting, the loading dose should comprise 7.5 mg.kg -1 given by pump over 30 minutes, followed immediately by 7.5 mg.kg -1 infused over 1.5 hours (i.e., 15 mg.kg -1 over 2 hours). Where this is not possible, the loading dose (15 mg.kg -1 ) should be added to 100 ml of crystalloid in an infusion bag (after wasting the balance), and infused over 2 hours. Maintenance doses of 10 mg.kg -1 should be given at 12-hour intervals, infused over 2 hours.
Intramuscular Use
Adults and Children
Quinine may be given intramuscularly to adults or children if intravenous administration is impossible. It must be given by deep injection into the anterior thigh, using sterile equipment and following thorough disinfection of the skin area. A loading dose of 20 mg.kg -1 is usual in adults, followed by 8-hourly maintenance doses. Young children should be given a loading dose of 15 mg.kg -1 , followed by 10 mg.kg -1 maintenance doses every 12 hours.
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