Roger P-M, Marty P, Prestifilippo L, Garaffo R, Hyvernat H, Dunais B, Chaillou S, Delaunay P, Bernardin G, Mattéi M, Le Fichoux Y, Dellamonica P
Service des Maladies Infectieuses et Tropicales, Hôpital de l'Archet, Centre Hospitalier Universitaire, Nice, France.
J Infect. 2002 Oct;45(3):160-4. doi: 10.1016/s0163-4453(02)91246-6.
Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.
自1996年以来，我们传染病科和重症监护病房针对恶性疟原虫疟疾制定了使用奎宁的通用方案。根据世界卫生组织标准，将患者分为非重症疟疾（UFM）或重症疟疾（SFM），将寄生虫血症>5%作为SFM的一项标准。SFM的治疗应包括静脉输注16mg/kg奎宁碱负荷剂量，持续4小时，随后每8小时输注8mg/kg。UFM患者每8小时接受8mg/kg奎宁碱治疗。治疗指数为10-15mg/l被认为是足够的。低血糖和心脏毒性是要研究的奎宁的两种主要不良反应。为了验证这些奎宁给药方式是否与足够的奎宁血药浓度相关，我们回顾了药理学数据和不良反应的发生情况。在1996年4月至2000年12月期间，95例患者住院治疗：25例为SFM，70例为UFM；95例患者中有78例（82%）接受了充分治疗，26例（28%）患者出现奎宁过量。即使在奎宁给药充分的情况下，也观察到6例严重不良反应。疟疾的共识性治疗并未带来足够的奎宁血药浓度，且毒性作用仍然常见。
