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Intravenous Quinine Therapy of Hospitalized Children with Plasmodium falciparum Malaria in Kinshasa, Zaire

Alan E. GreenbergMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Phuc Nguyen-DinhMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Farzin DavachiMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Bahwe YemvulaMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Nsuami MalandaMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Matadi NzezaMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Sharyon B. WilliamsMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Joanne F. de ZwartMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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Mayemba NzezaMalaria Branch and Control Technology Branch, Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control, Department of Pediatrics, Mama Yemo Hospital and Institut National de Recherche Biomedicale, Atlanta, Georgia

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To examine the clinical and parasitologic efficacy of quinine, we studied 34 children (7 months–13 years old) with severe or moderately severe Plasmodium falciparum infections. Quinine 10 mg/kg every 8 hr for 3 days was administered, initially by intravenous infusion of quinine formate followed by oral quinine dihydrochloride when tolerated. Thirty-three of the 34 patients were clinically well and had negative malaria smears 7 days after the initiation of therapy; 1 child, who presented in coma, died 29 hr after enrollment. The mean fever clearance time was 44.1 hr, and the mean parasite clearance time was 59.6 hr. A mean peak quinine level of 9.7 ppm was attained after the second dose of quinine, and the minimum concentration was maintained at 5–7 ppm during the 2nd and 3rd hospital days. In vitro testing was conducted with parasites from 10 patients: 9 isolates were resistant to chloroquine, and inhibition of schizont development with quinine occurred at a concentration of 8–32 pmol/well.

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