Definitive Treatment — Parenteral Quinine

Treatment

Parenteral quinine should be used for the treatment of severe malaria only in situations where parenteral artesunate is not available or is contraindicated.

For children

• Initial ('loading') dose 20 mg (quinine salt)/kg body weight: inject this dose into 10 ml/kg of 5% dextrose or half strength Darrow's and infuse over 3–4 hours.
• If patient has already received quinine for this illness, the first dose IV infusion should be 10 mg/kg diluted as above and given over 3–4 hours with no loading dose.
• Subsequent doses of 10 mg/kg should be given every 12 hours. The infusion should run for 3–4 hours. Continue the 5% dextrose or half strength Darrow's IV fluid (10 ml/kg given over 3–4 hours) between doses of quinine.

Stop intravenous quinine as soon as the patient can take food and fluids orally and at least 24 hours of parenteral quinine has been administered. Give age or weight appropriate doses of LA or DP beginning 12 hours after the last dose of quinine.

For adults

If the patient can be weighed, intravenous quinine is administered in the same manner as for children. If the patient cannot be weighed, IV quinine should be given as follows:

• First dose 900 mg in one litre of 5% dextrose or ½-strength Darrow's fluids given over 3–4 hours
• Subsequent doses 600 mg in one litre 5% dextrose or ½-strength Darrow's fluids every 12 hours given over 3–4 hours
• Continue the same IV fluids or Ringer's lactate (10 ml/kg given over 3–4 hours) between doses of quinine (Give a maximum of about 3 litres per 24 hours to avoid fluid overload)

Stop intravenous quinine as soon as the patient can take food and fluids orally and at least 24 hours of parenteral quinine has been administered. Give the appropriate dose of LA or DP beginning 12 hours of the last dose of quinine.

LA or DP should only be taken 12 hours after last dose of quinine to avoid cardiotoxicity.