Efficacy of loading versus standard doses of quinine in cerebral malaria

Objective To compare the efficacy of loading dose of quinine with the standard doses of quinine in cerebral malaria. Patients and Methods This study was conducted in Hayat Abad Medical Complex, Postgraduate Medical Institute, Peshawar from January 2009 to December 2009. Fifty consecutive cases of cerebral malaria fulfilling the WHO's diagnostic criteria for cerebral malaria were placed at random into two groups with 25 patients in each group. Group A patients received loading doses (20mg/kg body weight over 4 hours) of quinine followed by the standard dosages (10mg/kg body weight) and group B patients was administered standard doses of quinine. Clinical features as well as temperature and laboratory diagnosis for detection of Falciparum by microscopy was noted every twelve hours. Side effects were noted and blood sugar at baseline as well as at 12 hour interval was taken from all patients. A baseline ECG with daily monitoring for possible QT prolongation was done in all patients. Results In Group A, 22 (88%) patients recovered completely while three patients died (12%) and in Group B, 21(84%) patients recovered while four patients (16%) died. Four patients in group A developed hypoglycemia (16%) at 12 hours but none of the patient developed hypoglycemia in group B. Tinnitus and transient deafness were more common in patients recovering from coma in group A (20%). None of the patient had any evidence of QT prolongation or arrhythmia. Mean disappearance time of Plasmodium from the blood of Group A was 12 hours and in group B it was 36 hours. Mean time for regaining full consciousness with orientation in time space and person and no neurological deficit was 24 hours in group A and 36 hours in group B. Conclusion Loading dose of quinine seems to be well tolerated and may clear parasitaemia faster than standard doses of quinine.