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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2003 June;162(2-3):51-3

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Quinine treatment in severe Plasmodium falciparum malaria in children. A Holter monitoring

Bregani E. R. 1, Van Tien T. 1, Cabibbe M. 1, Aliberti S. 1, Figini G. 1, Manenti F. 2

1 Internal Medicine Department, Emergency Medicine Division, IRCCS Maggiore Hospital, University of Milan, Milan, Italy; 2 Mugana Hospital, Buboka Diocese, Tanzania


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Aim. Malar­ia has ele­vat­ed inci­dence and mor­tal­ity ­rate espe­cial­ly in Afri­can chil­dren. Stan­dard treat­ment in ­severe Plas­mo­di­um fal­cip­ar­um malar­ia is paren­ter­al qui­nine in ­most ­rural hos­pi­tals of devel­op­ing coun­tries, but lit­tle is ­known ­about the tox­ic­ity of qui­nine in chil­dren. Qui­nine has poten­tial ­heart tox­ic­ity due to pro­lon­ga­tion of the QT ­that ­could ­lead to the ­onset of dan­ger­ous ven­tric­u­lar arrhyth­mi­as. The aim of our ­work is the eval­u­a­tion of car­diac tox­ic­ity of i.v. qui­nine in chil­dren affect­ed by ­severe Plas­mo­di­um fal­cip­ar­um malar­ia.
Meth­ods. Ten chil­dren admit­ted to Muga­na hos­pi­tal (­North Tan­za­nia) affect­ed by ­severe malar­ia, ­were treat­ed ­with a load­ing ­dose of 20 mg/kg ­salt of qui­nine fol­lowed by 10 mg/kg eve­ry 8 ­hours. Hol­ter mon­i­tor­ing was per­formed for the ­first 24 ­hours of treat­ment ­with spe­cial atten­tion to ven­tric­u­lar and supra­ven­tric­u­lar arrhyth­mi­as, QT pro­lon­ga­tion and RR var­i­abil­ity.
­Results. No ­patient ­died, and treat­ment was ­well tol­er­at­ed. ­Heart ­rate ­means ­ranged ­between 100 and 156 bpm in the pop­u­la­tion stud­ied, ­with sin­gle val­ues ­from 56 to 186 bpm. Min­i­mal not sig­nif­i­cant supra­ven­tric­u­lar and ven­tric­u­lar arrhyth­mi­as ­were record­ed, ­with no ­more ­than 6 iso­lat­ed supra­ven­tric­u­lar extra­sys­toles and 6 supra­ven­tric­u­lar ­pairs of extra­sys­toles, and no ­more ­than 15 iso­lat­ed ven­tric­u­lar extra­sys­toles. No ­major, ­life threat­en­ing ven­tric­u­lar arrhyth­mi­as ­were ­observed. RR anal­y­sis did not ­show sig­nif­i­cant fluc­tu­a­tions.
Con­clu­sion. ­These ­data sug­gest ­that in the pedi­at­ric Afri­can pop­u­la­tion affect­ed by ­severe Plas­mo­di­um fal­cip­ar­um malar­ia qui­nine infu­sion ­seems to be ­well tol­er­at­ed.

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