Quinine Loading Dose in Cerebral Malaria

Nicholas J. WhiteFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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Sornchai LooareesuwanFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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David A. WarrellFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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Mary J. WarrellFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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Pornthep ChanthavanichFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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Danai BunnagFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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Tranakchit HarinasutaFaculty of Tropical Medicine, Mahidol University, Tropical Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Department of Tropical Medicine, Liverpool School of Tropical Medicine, 42016 Rajvithi Road, Bangkok 4, Thailand

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In cerebral malaria, the use of currently recommended doses of intravenous quinine may result in subtherapeutic plasma concentrations during the critical first 24 hours of treatment. A loading dose of quinine (20 mg/kg quinine dihydrochloride, equivalent to 16.7 mg/kg base, infused over 4 hours) proved a rapid and safe method of achieving plasma concentrations above the high minimum inhibitory concentrations for Plasmodium falciparum prevalent in Eastern Thailand.

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