Intrarectal quinine for treating Plasmodium falciparum malaria: a systematic review

Eisenhut, M., Omari, Aika and MacLehose, Harriet (2005) 'Intrarectal quinine for treating Plasmodium falciparum malaria: a systematic review'. Malaria Journal, Vol 4:24.

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Abstract

Background: In children with malaria caused by Plasmodium falciparum, quinine administered rectally may be easier to use and less painful than intramuscular or intravenous administration. The objective of this review was to compare the effectiveness of intrarectal with intravenous or intramuscular quinine for treating falciparum malaria.
Methods: All randomized and quasi-randomized controlled trials comparing intrarectal with intramuscular or intravenous quinine for treating people with falciparum malaria located through the following sources were included: Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS and CINAHL. Trial quality was assessed and data, including adverse event data, were extracted. Dichotomous data were analysed using odds ratios and continuous data using weighted mean difference.
Results: Eight randomized controlled trials ( 1,247 children) fulfilled the inclusion criteria. The same principal investigator led seven of the trials. Five compared intrarectal with intravenous quinine, and six compared intrarectal with intramuscular treatment. No statistically significant difference was detected for death, parasite clearance by 48 hours and seven days, parasite and fever clearance time, coma recovery time, duration of hospitalization and time before drinking began. One trial ( 898 children) reported that intrarectal was less painful than intramuscular administration.
Conclusion: No difference in the effect on parasites and clinical illness was detected for the use of intrarectal quinine compared with other routes, but most trials were small. Pain during application may be less with intrarectal quinine. Further larger trials, in patients with severe malaria and in adults, are required before the intrarectal route could be recommended.

Item Type:	Article
Additional Information:	The electronic version of this article is the complete one and can be found online at: http://www.malariajournal.com/content/4/1/24
Uncontrolled Keywords:	children pharmacokinetics injections poliomyelitis quinimax(r) africa efficacy niger
Subjects:	QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 256 Antimalarials QX Parasitology > Protozoa > QX 135 Plasmodia WB Practice of Medicine > Therapeutics > WB 340 Drug Administration WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
Faculty: Department:	Groups (2002 - 2012) > International Health Group
Digital Object Identifer (DOI):	https://doi.org/10.1186/1475-2875-4-24
Depositing User:	Martin Chapman
Date Deposited:	04 Oct 2011 17:13
Last Modified:	06 Feb 2018 13:03
URI:	https://archive.lstmed.ac.uk/id/eprint/1938

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