Barennes H, Mahaman Sani A, Kahia Tani F, Meda H, Khenine A
Unité d'Epidémiologie d'Intervention, Centre Muraz, Bobo Dioulasso, Burkina Faso.
Med Trop (Mars). 1999;59(4):383-8.
Pharmacokinetic studies have documented the efficacy of intrarectal quinine (IRQ) for treatment of childhood malaria. As a result, this technique has gradually supplanted intramuscular injection of quinine (IMQ), a common source of complications in children. To assess the safety of this technique, outcome was routinely monitored from 1987 to 1997. This report presents immediate tolerance observed in clinical studies involving 915 children as well as two surveys conducted in Niamey, Niger on 2764 children in 1995 and on 714 children in 1997. In the second study tolerance of IRQ (n = 364) and IMQ (n = 350) was compared. Long-term tolerance was evaluated for 11 years in a single location, i.e. Morondava, Madagascar. In 1995 IRQ accounted for 19.6 p. 100 of antimalarial treatments prescribed in Niamey. In 1997, IRQ accounted for 34.5 p. 100 of quinine prescriptions (excluding infusions) written in medical centers and 65.7 p. 100 in the Pediatric Department B of the hospital in Niamey. Overall tolerance was good, thus confirming previous clinical studies. No major and/or irreversible complication was observed. Early rejection (12.9 p. 100), intestinal transit problems (4.3 p. 100), and watery stools (12.9 p. 100) were the most common problems. In contrast, IMQ led to residual pain (3.1 p. 100), local inflammation (3.1 p. 100), abscess (0.6 p. 100), and lower extremity disability (0.3 p. 100). The precautions for use, e.g. proper dilution, and staff training requirements are reviewed in the discussion.
药代动力学研究已证明直肠内注射奎宁（IRQ）治疗儿童疟疾的疗效。因此，该技术已逐渐取代肌肉注射奎宁（IMQ），后者是儿童并发症的常见来源。为评估该技术的安全性，于1987年至1997年对结果进行了常规监测。本报告介绍了在涉及915名儿童的临床研究中观察到的即时耐受性，以及1995年在尼日尔尼亚美对2764名儿童和1997年对714名儿童进行的两项调查。在第二项研究中，比较了IRQ（n = 364）和IMQ（n = 350）的耐受性。在马达加斯加的穆龙达瓦单一地点对长期耐受性进行了11年的评估。1995年，IRQ在尼亚美开出的抗疟治疗处方中占19.6%。1997年，IRQ在医疗中心开出的奎宁处方（不包括输液）中占34.5%，在尼亚美医院儿科B部占65.7%。总体耐受性良好，从而证实了先前的临床研究。未观察到重大和/或不可逆并发症。早期排斥反应（12.9%）、肠道转运问题（4.3%）和水样便（12.9%）是最常见的问题。相比之下，IMQ导致残留疼痛（3.1%）局部炎症（3.1%）、脓肿（0.6%）和下肢残疾（0.3%）。讨论中回顾了使用注意事项，如适当稀释以及工作人员培训要求。
