Treatment of falciparum malaria with intra muscular quinine in a rural area of Thailand.

The study was carried out in 32 adult cases of falciparum malaria who had nausea and vomiting. All patients were admitted in Chomboeng Crown Prince Hospital, Ratchaburi Province, during April-December 1981. Patients were treated with 600 mg of quinine dihydrochloride intramuscularly every 8 hours until nausea and vomiting subsided and the drug could be given orally. Quinine was given 8 hourly for 7 days. Parasites were cleared from the blood by D3 in 26 cases, and by D5 in 4 cases. Fever was cleared in a mean of 2.8 days after the treatment. In the other 2 cases, intravenous quinine was given instead of intramuscular quinine on D2 and D3 respectively and parasitaemia was cleared within D7 in both cases. In 13 cases, serum quinine concentrations were measured prior to the first injection of quinine, then 4 hours, and 8 hours later. In other 6 cases, the measurements were carried out prior to the first injection and 4 hours later only. In 5 patients, quinine was present in the baseline blood sample. In the other 14 patients, mean serum quinine concentration at 4 hours was 19.43 n mol/ml. The mean serum quinine concentration at 8 hours in 8 patients was 22.0 n mol/ml. Therapeutic serum concentrations can be attained by intramuscular injection of quinine.