ABSTRACT
Muy a pesar de la existencia de variados grupos de fármacos antimaláricos, en muchas partes del mundo continúan siendo fármacos de primera línea para el tratamiento de la malaria o paludismo la Quinina y sus congéneres. Dado que esta patología es capaz de afectar al ser humano expuesto en cualquier etapa de la vida, la posibilidad de interacción de los fármacos antimaláricos conjuntamente con cualquier otro tipo de medicación, ya por la presencia en el paciente afecto de malaria, de alguna otra patología, sea esta de carácter agudo o crónico, nos motivaron a la ejecución de la presente revisión, sumándole a ello además variadas reacciones adversas de importancia clínica. En lo que respecta al embarazo y lactancia podemos considerar que, en general, la mayoría de estos antimaláricos son seguros y eficaces durante el embarazo, no constituyendo este estado fisiológico una contraindicación absoluta para su empleo, sin embargo, debe valorarse en cada caso la relación riesgo/beneficio.
Subject(s)
Antimalarials , Drug Interactions , Amodiaquine/adverse effects , Chloroquine/adverse effects , Hydroxychloroquine/adverse effects , Mefloquine/adverse effects , Quinidine/adverse effects , Quinine/adverse effectsABSTRACT
L'injection intra-musculaire de quinine; traitement habituel de l'acces palustre chez l'enfant; est trop souvent a l'origine de complications orthopediques graves : paralysie sciatique apres injection intrafessiere; raideur du genou en extension apres injection intraquadricipitale. A partir d'une serie de 98 cas; dont 88 operes; les auteurs etudient les tableaux cliniques presentes et ils insistent sur la gravite des sequelles fonctionnelles. Ils analysent les possibilites therapeutiques des sequelles : au niveau du pied correction selon l'age par liberation interne ou double arthrodese sous-talienne et mediotarsienne; associee a une stabilisation par transposition antero-externe du tendon du tibial posterieur qui est tres habituellement non paralyse. Au niveau du genou; les auteurs proposent une correction par desinsertion large du quadriceps; intervention plus lourdemais dont les resultats sont meilleurs que la simple plastie d'allongement du tendon quadricipital
Subject(s)
Malaria , Quinine/adverse effectsABSTRACT
OBJECTIVE: To study the comparative efficacy of the quinine and artesunate in complicated malaria in children. METHODS: All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests. RESULTS: 80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 +/- 31.49 hrs; 43.55 +/- 20.12 hrs, and 41.67 +/- 16.78 hrs respectively) as compared to the quinine group (70.15 +/- 17.56 hrs, 62.23 +/- 16.99 hrs, and 52.24 +/- 12.69 hrs respectively) ( p<0.05) No side effects were observed in the artesunate treated group. CONCLUSION: Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.
Subject(s)
Adolescent , Antimalarials/adverse effects , Artemisinins/adverse effects , Child, Preschool , Female , Headache/chemically induced , Humans , Malaria, Falciparum/drug therapy , Male , Nausea/chemically induced , Quinine/adverse effects , Sesquiterpenes/adverse effects , Treatment Outcome , Vomiting/chemically inducedABSTRACT
Blackwater fever is a rare manifestation of falciparum malaria characterized by sudden intravascular hemolysis followed by fever and hemoglobinuria. We present a case of blackwater fever, having occurred after administration of quinine, which was treated successfully with artemether.
Subject(s)
Adult , Antimalarials/therapeutic use , Artemisinins , Blackwater Fever/chemically induced , Humans , Male , Quinine/adverse effects , Sesquiterpenes/therapeutic useABSTRACT
Qinghaosu and its derivatives are rapidly effective antimalarial drugs derived from a Chinese plant (sweet worm wood). Preliminary studies suggest that these drugs may be more effective than quinine in the treatment of Plasmodium falciparum malaria. A randomised double blind trial was conducted in 52 cases of Plasmodium falciparum malaria cases. In all 26 cases were given artemether and another 26 were given quinine. There were 2 (7.5%) deaths in artemether group and 4 (15%) deaths in quinine group. The parasites were cleared more quickly from the blood in artemether group when compared to quinine group (mean-72 hrs vs 96 hrs). Resolution of fever was comparable in both artemether and quinine group (mean-84 hrs vs 78 hrs) and also the average time of recovery from coma was more earlier in artemether group (mean-60 hrs vs 72 hrs). The only side effect noticed with artemether therapy was gastrointestinal (GI) intolerance while quinine therapy was associated with myocarditis, hypotension, hypoglycemia and GI intolerance.
Subject(s)
Adolescent , Adult , Animals , Antimalarials/adverse effects , Artemisinins , Double-Blind Method , Female , Humans , India , Malaria, Falciparum/drug therapy , Male , Middle Aged , Plasmodium falciparum/isolation & purification , Quinine/adverse effects , Sesquiterpenes/adverse effectsABSTRACT
The effect of intramuscular artemether (intramuscular loading dose of 160 mg, followed by 80 mg daily for another 6 doses), in comparison with that of quinine (intravenous infusion of loading dose of 20 mg/kg, followed by 10 mg/kg q 8 hourly for 7 days), on the electrocardiograph of severe falciparum malaria patients were investigated in 102 Thai patients (92 males, 10 females) admitted to Pra Pokklao Hospital, Chantaburi, southeast of Thailand. Fifty patients (19 with quinine and 31 with artemether) were eligible for ECG analysis. Hypotension was found significantly more common in the quinine group (13 vs 2 cases). Thirteen, 5 and 1 patients with quinine treatment, respectively, had tachycardia, non-specific T-wave change and QTc prolongation. No significant dysrhythmia was found despite high plasma quinine concentrations. Five patients died; their ECGs were not significantly different from those who survived. In the group with intramuscular artemether, 17 cases had tachycardia prior to artemether treatment. QTc prolongation and non-specific T-wave change were found in 2 and 6 cases. One patient had RBBB and second degree AV-block on Day 1, but returned to normal on Day 2. No other dysrhythmia or other significant changes in ECG tracing which would suggest any effect of artemether on cardiovascular system were observed.
Subject(s)
Adolescent , Adult , Aged , Antimalarials/adverse effects , Arrhythmias, Cardiac/chemically induced , Artemisinins , Electrocardiography/drug effects , Female , Humans , Hypotension/chemically induced , Infusions, Intravenous , Injections, Intramuscular , Injections, Intravenous , Malaria, Falciparum/drug therapy , Male , Middle Aged , Quinine/adverse effects , Sesquiterpenes/adverse effectsSubject(s)
Humans , Male , Antimalarials/adverse effects , Child , Myocardium , Quinine/adverse effects , Heart/drug effectsABSTRACT
La quinine utilisee par voie intraveineuse est sans doute tres efficace pour le traitement des acces pernicieux de paludisme. Cette utilisation peut entrainer des episodes d'hypoglycemie severe pouvant conduire aux comas hypoglycemiques. Devant un patient qui a une forte parasitemie; une insuffisance renale; il faut doser les glycemies et associer du serum glucose 5 pour cent ou 10 pour cent lorsqu'on utilise la quinine par voie intraveineuse
Subject(s)
Coma , Hypoglycemia , Malaria/drug therapy , Quinine/adverse effectsABSTRACT
Quinine, a cinchona alkaloid, was investigated for putative anxiogenic activity in view of clinical reports suggesting that it induces anxiety and apprehension following its use in malaria. The experimental paradigms chosen to elucidate anxiogenic activity have been shown to stand the tests of reliability and validity. Yohimbine, which has been shown to induce anxiety both in animals and in man, was used for comparison. Quinine was found to elicit a complex behavioural profile of activity ranging from overt central stimulation to marked central depression on dose increment. The doses 10 and 20 mg/kg, ip, of quinine chosen to investigate anxiogenic activity were comparable to those induced by 2.5 and 5 mg/kg ip of yohimbine. Quinine induced a dose-related anxiogenic activity in the open-field and elevated plus-maze tests in mice, and the social interaction and thirst conflict tests in rats, similar to effects induced by yohimbine. In addition, both quinine and yohimbine attenuated the effects of diazepam, an anxiolytic agent, in the open-field and thirst conflict tests. The results indicate that quinine exerts significant anxiogenic effect at a particular dose range.
Subject(s)
Analysis of Variance , Animals , Anxiety/chemically induced , Diazepam/adverse effects , Dose-Response Relationship, Drug , Drinking Behavior/drug effects , Interpersonal Relations , Male , Movement/drug effects , Quinine/adverse effects , Rats , Rats, Inbred Strains , Yohimbine/adverse effectsABSTRACT
Plasmodium falciparum malarial parasites are increasingly becoming resistant to most available therapeutic drugs; except quinine. Unfortunately this drug may produce some very adverse and permanent side effects. Very often there is individual hypersensitivity to quinine and sudden blindness in both eyes may occur. Children should be given syrup quinine instead of tablets or injections
Subject(s)
Malaria/drug therapy , Quinine/adverse effectsABSTRACT
Em 100 pacientes com malária por Plasmodium falciparum, 63 tratados com cloroquina (50 a 90 mg/Kg peso, em 3 a 6 dias) e 46 com quinina (1,5 g/dia, durante 7 dias), foram estudadas a cardiotoxicidade e resposta terapêutica dessas drogas. A avaliaçåo da cardiotoxicidade baseou-se em achados clínicos, evoluçåo eletrocardiográfica e determinaçåo dos níveis enzimáticos (transaminase glutâmico-oxalacética e creatinafosfotransferase) antes, durante e após o tratamento. Quanto à cloroquina, a cardiotoxicidade manifestou-se principalmente sobre os mecanismos da repolarizaçåo ventricular (42,8 por cento), embora tenha ocorrido, com muito menor frequência, depressåo da excitabilidade (4,7 por cento), retardo na conduçåo do estímulo elétrico (14,2 por cento), arritmia supraventricular (1,6 por cento) e queda da pressåo arterial (3,2 por cento). Em relaçåo à quinina a depressåo da excitabilidade (bradicardia) foi a manifestaçåo mais significativa (34,7 por cento); foram também detectadas alteraçoes da repolarizaçåo ventricular (15,2 por cento), retardo na conduçåo do estímulo elétrico (19,5 por cento) e queda da pressåo arterial (21,7 por cento). No tacante à resposta terapêutica, nåo houve resistência a nível de RII e RIII, segundo os padroes da Organizaçåo Mundial de Saúde, com quaisquer das drogas. A cloroquina apresentou 15,0 por cento de resistência (RI) e a quinina 2,4 por cento. Ambas as drogas mostraram-se eficazes para o tratamento da doença, sobretudo nas formas graves, nåo tendo havido diferença importante em relaçåo à resposta clínica, apesar da açåo esquizonticida dacloroquina ter se mostrado discretamente mais rápida que a da quinina.