Clinical Pharmacology of the Antimalarial Quinine in Children

Quinine is the best studied drug for treating severe malaria in very young children. Quinine may be administered in pregnancy and, at therapeutic doses, malformations have not been reported. Some strains of quinine from Southeast Asia and South America have become resistant. Quinine is the treatment of choice for the drug-resistant severe Plasmodium falciparum. The antimalarial mechanism of quinine is the binding to heme preventing its detoxification. The dose of quinine is 10 mg/kg every 12 hours, and it may be administered orally, intramuscularly or intravenously. When it is administrated intravenously it must be infused slowly over 2 to 4 hours. The treatment of severe/complicated childhood malaria appears to be evolving, and in 2005, the Indian Academy of Pediatrics Guideline recommended quinine, suggesting that artesunate/artemether was the less preferred alternative. In 2008, the Infectious Diseases Chapter, Indian Academy of Pediatrics recommended quinine with tetracycline/doxycycline/clindamycin in line with the WHO 2006 statement. In 2010, the WHO recommended aresunate for treating malaria infection, positioning quinine as an alternative. Malaria is caused by three parasites namely: Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale. Plasmodium falciparum is the most common and virulent parasite. These parasites are present in different areas of the sub-Saharan African countries and Asia. In 2010, there were estimated 219 million cases of malaria resulting in 666,000 deaths and two-thirds were children. Children are more vulnerable than adults to malaria parasites. The aim of this study is to review the published data on the clinical pharmacology of quinine in children.