Electrocardiographic abnormalities with quinine and artesunate combinations in comparison to quinine or artesunate alone in severe falciparum malaria
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20204089Keywords:
Artesunate, Electrocardiogram, QuinineAbstract
Background: In Multi drug resistant falciparum malaria anti-malarial combinations are frequently used i.e. Quinine and IV Artesunate. Quinine is associated with electrocardiographic disturbances. Artesunate in high dose produce QTC prolongation in animal models, so the electrocardiogram (ECG) is thoroughly studied.
Methods: Severe falciparum malaria cases 15 to 60 years were randomly allocated into 3 treatment regimens i.e. Artesunate, Quinine alone and their combination. Electrocardiographic recordings were taken periodically in 3 groups and compared statistically.
Results: The mean QTC interval is significantly prolonged in combination treatment group from 0.40+0.02 to 0.49+0.09 (P<0.05) ECG disturbance (44%). QTC prolongation was commonest (i.e. 27%) with electrolyte imbalance could produce life threatening cardiac arrhythmia (Polymorphic VT with Sr K+ 2.9). Artesunate alone was list prone (i.e. only 6%) Quinine though has comparatively more (i.e. 25%) but there is no life-threatening cardiac arrhythmia in artesunate and Quinine.
Metrics
References
Newton PN, Chierakul W, Ruangveerayuth R, Silamut K, Teerapong P, Krudsood S et al. A comparison of artesunate alone with combined artesunate and quinine in the parenteral treatment of acute falciparum malaria. Trans R Soc Trop Med Hyg. 2001;95(5):519-25.
Newton PN, Chierakul W, Ruangveerayuth R, Silamut K, Teerapong P, Krudsood S, et al. A comparison of artesunate alone with combined artesunate and quinine in the parenteral treatment of acute falciparum malaria. Trans R Soc Trop Med Hyg. 2001;95(5):519-25.
WHO, 2004: World Health Report. Report of the Director General WHO; 2004.
Artemether-Quinine Meta-analysis Study Group. A meta-analysis using individual patient data of trials comparing artemether with quinine in the treatment of severe falciparum malaria. Trans R Soc Trop Med Hyg. 2001;95(6):637-50.
Krishna S, White NJ. Pharmacokinetics of quinine, chloroquine and amodiaquine. Clinical implications. Clin Pharmacokinet. 1996;30(4):263-99.
Goodman and Gillman’s: The pharmacological Basis of Therapeutics; 10th edn, 2004. Chapter 40; James W Tracy and Leslie T Webster; Drugs used in the chemotherapy of protozoal infections malaria.
Bateman DN, Dyson EH. Quinine toxicity. Adverse Drug React Acute Poisoning Rev. 1986;5:215-33
White NJ, Looareesuwan S, Warrell DA, Warrell MJ, Chanthavanich P, Bunnag D et al. Quinine loading dose in cerebral malaria. Am J Trop med Hyg. 1983;32(1):1-5.
Therapeutic drugs: 2nd Edition 2002: Artemisinin: Edited by Colin Dollery. Churchil Living Stone. P.208-13
Win K, Jhan M. Comparison of combinations of parenteral artemisinin derivatives plus oral mefloquine with IV quinine plus tetracycline for treating cerebral malaria; Bulletin of the WHO. 1992;70:777-82.
Harrison’s Principle of Internal Medicine, 16thEdn, 2005. Chapter 195 by Nicholas J White, Joel G Breman Malaria and Babesiosis: Disease caused by Red Blood Cell. Parasites. Page-1218
Malaria: Principles and Practice of Malariology. Vol.2. edited by Walther H, Wernsdorfer and Sir Ian Migregor. Churchill Living Stone, 1988.
China Co-operative Research Group on quinghaosu and its derivatives as antimalarias; The Chemistry and synthesis of quinghaosu derivatives. J Traditional Chinese Med. 1982;2:9-16.
Martin Bland. An Introduction to Medical Statistics, Oxford Medical Publications, edn 3,1987.
ames E. De Muth. Basic statistics and Pharmaceutical statistical application. Publisher, Dekan Inc. New York, 1999; 821.
Bateman DN, Dyson EH. Quinine toxicity. Adverse Drug React Acute Poisoning Rev. 1986;5:215-33.
China Co-operative Research Group on quinghaosu and its derivatives as antimalarias 1982(c) Antimalarial efficacy and mode of action of quinghaosu and its derivatives in experimental models. Journal of Traditional Chinese Medicine.
Devries PJ and Dien TK: Clinical pharmacology & therapeutic potential of artemisinin and its derivatives in the treatment of malaria. Drugs, 1996;52:818-36.
International Artemisinin study group-Artesunate combinations for treatment of malaria, metaanalysis, Lancet. 2004;363:9-17.