Ce protocole couvre le paludisme se présentant avec une parasitémie asexuée confirmée associée à au moins un critère défini de maladie grave.
Un ou plusieurs des critères suivants définissent cette présentation clinique :
Severe falciparum malaria: For epidemiological purposes, severe falciparum malaria is defined as one or more of the following, occurring in the absence of an identified alternative cause and in the presence of P. falciparum asexual parasitaemia.
Impaired consciousness: A Glasgow coma score < 11 in adults or a Blantyre coma score < 3 in children
Multiple convulsions: More than two episodes within 24 h
Hypoglycaemia: Blood or plasma glucose < 2.2 mmol/L (< 40 mg/dL)
Hyperparasitaemia: P. falciparum parasitaemia > 10%
Quinine is retained as an option for treating severe malaria when artesunate or artemether is not available or is contraindicated.
Studies of pharmacokinetics show that a loading dose of quinine (20 mg salt/kg bw, twice the maintenance dose) provides therapeutic plasma concentrations within 4 h.
The maintenance dose of quinine (10 mg salt/kg bw) is administered at 8-h intervals, starting 8 h after the first dose.
If there is no improvement in the patient's condition within 48 h, the dose should be reduced by one third, i.e. to 10 mg salt/kg bw every 12 h.
Each dose of parenteral quinine must be administered as a slow, rate-controlled infusion (usually diluted in 5% dextrose and infused over 4 h).
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