Este protocolo abrange a malária que se apresenta com parasitemia assexuada confirmada, juntamente com pelo menos uma característica definida de doença grave.
Uma ou mais das seguintes características define esta apresentação clínica:
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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