Gupta Parul, Narang Manish, Gomber Sunil, Saha Rumpa
a Department of Paediatrics , University College of Medical Sciences and Guru Tegh Bahadur Hospital, University of Delhi , Delhi , India.
b Department of Microbiology , University College of Medical Sciences and Guru Tegh Bahadur Hospital, University of Delhi , Delhi , India.
Paediatr Int Child Health. 2017 May;37(2):139-143. doi: 10.1080/20469047.2016.1209883. Epub 2016 Jul 26.
There are several case reports of quinine-induced thrombocytopenia but no clinical trials to ascertain its incidence and significance in severe malaria.
The primary objective was to assess the effect of quinine on the platelet count in children with severe malaria and to compare it with artesunate combination therapy (ACT), and the secondary objective was to assess outcome of treatment with quinine and ACT.
An open-labelled, randomised, controlled trial was undertaken in 100 children aged 6 months to 12 years who were diagnosed with malaria by microscopy and/or rapid diagnostic test kits with at least one WHO clinical or laboratory criterion for severe malaria. All subjects were commenced on either quinine or ACT. Clindamycin was added to artesunate as a combination drug (ACT). It was also given to patients on quinine to avoid its confounding effect on the results. Platelet counts were undertaken every 24 hours for 7 consecutive days, temperature and coma score (Blantyre coma score ≥3 in children <4 years or Glasgow coma score ≥13 in children >4 years) was recorded 6-hourly and peripheral smears were taken 12-hourly until two consecutively negative smears were obtained. The primary outcome was a fall in the platelet count by ≥20% from the time of drug initiation until day 7. The secondary outcome was comparison of the efficacy, parasite clearance time, fever clearance time, coma recovery time and adverse effects of quinine vs ACT.
30.4% patients in the quinine group (n = 48) had ≥20% fall in platelet count and 10.8% of patients in the ACT group (n = 46) (P = 0.02). Despite the fall in platelet count, there was no bleeding. The efficacy of ACT was significantly better than quinine but the other treatment outcomes showed insignificant difference.
Quinine should be used with caution in patients with severe malaria because of the potential risk of quinine-induced thrombocytopenia.
有几例关于奎宁诱导血小板减少症的病例报告，但尚无临床试验来确定其在重症疟疾中的发生率和意义。
主要目的是评估奎宁对重症疟疾患儿血小板计数的影响，并将其与青蒿琥酯联合疗法（ACT）进行比较，次要目的是评估奎宁和ACT的治疗效果。
对100名年龄在6个月至12岁的儿童进行了一项开放标签、随机、对照试验，这些儿童通过显微镜检查和/或快速诊断试剂盒被诊断为疟疾，且至少符合一项世界卫生组织关于重症疟疾的临床或实验室标准。所有受试者均开始接受奎宁或ACT治疗。将克林霉素添加到青蒿琥酯中作为联合药物（ACT）。也给接受奎宁治疗的患者使用该药，以避免其对结果产生混杂影响。连续7天每24小时进行一次血小板计数，每6小时记录一次体温和昏迷评分（4岁以下儿童的布兰太尔昏迷评分≥3或4岁以上儿童的格拉斯哥昏迷评分≥13），每12小时进行一次外周血涂片检查，直至获得两张连续阴性涂片。主要结局是从开始用药到第7天血小板计数下降≥20%。次要结局是比较奎宁与ACT的疗效、寄生虫清除时间、发热清除时间、昏迷恢复时间和不良反应。
奎宁组（n = 48）中30.4%的患者血小板计数下降≥20%，ACT组（n = 46）中10.8%的患者血小板计数下降≥20%（P = 0.02）。尽管血小板计数下降，但未出现出血情况。ACT的疗效明显优于奎宁，但其他治疗结局显示差异不显著。
由于奎宁有诱导血小板减少症的潜在风险，重症疟疾患者使用奎宁时应谨慎。
