Official websites use. Share sensitive information only on official, secure websites. Objective To compare the safety and efficacy of quinine given by the rectal route with quinine given by the intramuscular route in children with moderately severe Plasmodium falciparum malaria.
Participants children with moderately severe P falciparum malaria who were unable to take oral treatment. Main outcome measures Primary safety outcome was the presence of blood in stools and secondary safety outcome was diarrhoea. Primary efficacy outcome was early treatment failure and secondary efficacy outcomes were late clinical and parasitological failures, fever clearance time, and time to oral intake.
Side effects of rectal quinine were rare and transitory. All except two children in each group had negative blood slide results at day 5. Other efficacy outcomes late clinical failure, late parasitological failure, fever clearance time, time to starting oral intake and rate of deterioration to severe malaria did not differ. Conclusion Quinine given by the rectal route has an acceptable safety profile and could be used in the early management of moderately severe malaria in children in sub-Saharan Africa, halting progression to severe disease.
Most of the million deaths from malaria each year, primarily of African children aged under 5 years, occur at home or at the first level of health care, 1 when intravenous infusion of quinine is often unsuitable. If oral treatment is not possible, quinine is usually given by the intramuscular route, although often unsafely. We compared the safety and efficacy of rectal quinine compared with intramuscular quinine in children with moderately severe malaria.
In this malaria endemic area, isolates are fully sensitive to quinine. Parents or guardians gave informed written consent. We excluded children with a history of diarrhoea, current anal disease, or those who had received a traditional enema in the preceding week. On enrolment we carried out a complete medical history and physical examination.
