Notices to Readers
Treatment of Severe Plasmodium falciparum Malaria with
Quinidine Gluconate: Discontinuation of Parenteral Quinine
from CDC Drug Service
CDC has recently reviewed data on the reported incidence in
the United States of Plasmodium falciparum malaria and has
evaluated information on the effective management of severe
life-threatening infections. As a result of this review, CDC has
concluded that the drug of choice in the United States for
treatment of complicated P. falciparum infections is parenteral
quinidine gluconate. Therefore, effective immediately, parenteral
quinine dihydrochloride will no longer be available from the CDC
Drug Service.
Patients with severe malaria in the United States should be
treated in intensive-care facilities where central hemodynamic
and electrocardiographic monitoring is available. Based on a
study of patients with P. falciparum treated in the United States
(1), continuous infusion of quinidine gluconate is recommended. A
loading dose of 10 mg of quinidine gluconate (equivalent to 6.2
mg quinidine base) per kg of body weight is given over 1-2 hours,
followed by a constant infusion of 0.02 mg quinidine gluconate
per kg per minute. This regimen is highly effective and
well-tolerated in monitored patients (2,3).
The Food and Drug Administration and the drug manufacturer
are amending the indications for the use of quinidine gluconate
to include therapy of life-threatening P. falciparum malaria.
Reasons for recommending the routine use of parenteral
quinidine gluconate in the United States include the demonstrated
efficacy and safety of parenteral quinidine gluconate and the
unavailability of parenteral quinine that has caused delays in
administering an antimalarial drug to critically ill persons. An
expanded report on the use of quinidine gluconate for the
treatment of P. falciparum malaria will be published in an MMWR
Recommendations and Reports. Information regarding treatment of
P. falciparum malaria is available from the Malaria Branch,
Division of Parasitic Diseases, Center for Infectious Diseases,
CDC, telephone (404) 488-4046.
Reported by: Malaria Br, Div of Parasitic Diseases, Center for
Infectious Diseases, CDC.
References
Miller KD, Greenberg AE, Campbell CC. Treatment of malaria in
the United States with a continuous infusion of quinidine
gluconate and exchange transfusion. N Engl J Med 1989;321:65-70.
White NJ, Plorde JJ. Malaria. In: Wilson JD, Braunwald E,
Isselbacher KJ, et al, eds. Harrison's principles of internal
medicine. 12th ed. New York: McGraw-Hill, 1990.
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