Why Quinine Along With Artimisinin Compound is Harmful

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ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
Why Quinine if given along with artimisinin compound is harmful or having no additive effect?
Answer
Both quinine and artemisin compounds have the same side effects and thus may have an additive effect on the adverse effects. Also there is no added advantage by giving both the drugs together for treatment of malaria. In fact as per the latest WHO recommendations For children in high transmission areas, the following antimalarial medicines are recommended for severe malaria: artesunate 2.4 mg/kg bw i.v. or i.m. given on admission (time = 0), then at 12 h and 24 h, then once a day; OR artemether 3.2 mg/kg i.m. given on admission then 1.6 mg/kg bw per day; OR quinine 20 mg salt/kg on admission (i.v. infusion or divided i.m. injection), then 10 mg/kg bw every 8 h; infusion rate should not exceed 5 mg salt/kg bw per hour. Randomised trials comparing artesunate and quinine from South-East Asia show clear evidence of benefit with artesunate. In the largest multi-centre trial, which enrolled 1461 patients (including 202 children <15 years old), mortality was reduced by 34.7% compared to the quinine group. The results of this and smaller trials are consistent and suggest that artesunate is the treatment of choice for adults with severe malaria. There are, however, still insufficient data for children, particularly from high transmission settings to make the same conclusion. An individual patient data meta-analysis of trials comparing artemether and quinine showed no difference in mortality in African children. Back to All Questions

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