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Evidence summaries

High First Dose Quinine Regimen for Treating Severe Malaria

High first dose quinine regimen appears to reduce fever clearance time and parasite clearance time in severe malaria. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 4 trials with a total of 144 subjects. Loading dose was associated with fewer deaths, but this was not statistically significant (RR 0.62, 95% CI 0.19 to 2.04, 3 trials). Loading dose was associated with faster clearance of parasites (WMD -7.44 hours, 95% CI -13.24 to -1.64 hours, 2 trials) and resolution of fever (WMD -11.11 hours, 95% CI -20.04 to -2.18 hours, 2 trials). No statistically significant difference was detected for recovery of consciousness, neurological sequelae, or convulsions, but the numbers were small.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding).

    References

    • Lesi A, Meremikwu M. High first dose quinine regimen for treating severe malaria. Cochrane Database Syst Rev 2004;(3):CD003341 [Review content assessed as up-to-date: 18 February 2009]. [PubMed]

Primary/Secondary Keywords