Correspondence
Availability of Intravenous Quinidine for falciparum Malaria
N Engl J Med 1996; 335:138July 11, 1996
- Article
To the Editor:
Intravenous quinidine, the treatment of choice for patients with life-threatening falciparum malaria, is no longer available at many hospitals. A four-year-old boy, born in the United States, was brought to San Francisco General Hospital in April 1996 after two days of fever, malaise, and watery diarrhea that began three weeks after his return from a three-week visit to Sierra Leone. He had not received malaria chemoprophylaxis. The child was intermittently somnolent and had an enlarged spleen. The hematocrit was 28.1 percent, the platelet count 71,000 per cubic millimeter, and the peripheral-blood smear showed that 8 to 10 percent of erythrocytes were infected with ring forms of Plasmodium falciparum.
Intravenous quinidine was ordered, and the patient was transferred to the intensive care unit. We then learned that our hospital and a number of other local hospitals no longer stock intravenous quinidine. Therapy with oral quinine sulfate and intravenous clindamycin was begun, quinidine was subsequently acquired from another hospital, and the patient received his first dose about six hours after his arrival. An exchange transfusion was considered, but the patient's condition improved rapidly with quinidine and clindamycin. Three days after admission, he was discharged taking oral quinine and clindamycin.
Falciparum malaria is diagnosed hundreds of times each year in the United States.1 Severe cases, as in our patient, with a high level of parasitemia and possible early manifestations of cerebral malaria, are medical emergencies.2 Resistance to chloroquine and other antimalarial agents is common, and oral drug delivery problematic. The treatment of choice is intravenous quinine or quinidine. Intravenous preparations of quinine were previously provided by the Centers for Disease Control and Prevention at international airports, but this practice was discontinued because intravenous quinidine was shown to be as effective as quinine.3 With changes in cardiologic care, intravenous quinidine is no longer routinely available for use as an antiarrhythmic agent. Because falciparum malaria progresses rapidly, we urge that hospitals maintain small supplies of quinidine or have an established system for acquiring it rapidly in the event that patients present with severe falciparum malaria.
3 ReferencesPhilip J. Rosenthal, M.D.
Carolyn Petersen, M.D.
Francesca R. Geertsma, M.D.
Steve Kohl, M.D.
University of California, San Francisco, San Francisco, CA 941431
Malaria surveillance -- United States, 1992
Medline2
World Health Organization Malaria Action Programme
CrossRef | Web of Science | Medline3
Phillips RE ,Warrell DA ,White NJ ,Looareesuwan S ,Karbwang J . Intravenous quinidine for the treatment of severe falciparum malaria: clinical and pharmacokinetic studies. N Engl J Med 1985;312:1273-1278
Full Text | Web of Science | Medline
- Citing Articles (7)
Citing Articles
1
Rosenthal, Philip J., . (2008) Artesunate for the Treatment of Severe Falciparum Malaria. New England Journal of Medicine 358:17, 1829-1836
Full Text2
R.C. Vickery, Daniel L. Klayman. 2007. Malaria. .
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Alan J. Magill. (2006) Malaria: Diagnosis and treatment of falciparum malaria in travelers during and after travel. Current Infectious Disease Reports 8:1, 35-42
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Gregory H. Bledsoe. (2005) Malaria Primer for Clinicians in the United States. Southern Medical Journal 98:12, 1197-1204
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LAUREL MOODY, JENNIFER MacALISTER, LOUIS C. HAMPERS. (2000) Management of life-threatening malaria. Pediatric Emergency Care 16:6, 426-428
CrossRef6
Alan J. Magill. (1998) FEVER IN THE RETURNED TRAVELER. Infectious Disease Clinics of North America 12:2, 445-469
CrossRef7
Jay P Sanford. (1996) Dosage for malaria treatment. The Lancet 348:9037, 1311
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