LOADING DOSE OF QUININE IN AFRICAN CHILDREN WITH CEREBRAL MALARIA

The majority of deaths from cerebral malaria occur within 48 h after a dmission to hospital. Because of the possibility of inadequate treatme nt within this period, the use of a loading dose of quinine has been p roposed. We reviewed clinical and laboratory data for 113 children wit h cerebral malaria, who were treated with intravenous quinine, 10 mg/k g every 8 h, at Macha Mission Hospital in rural Zambia. In 1990-1991, 39 children were not given a loading dose of quinine while, in 1992-19 93, 74 children received a loading dose of 20 mg/kg. Elevated serum ir on levels, as reflected in transferrin saturation, were strongly assoc iated with higher mortality. A loading dose of quinine was associated with faster recovery from coma and enhanced clearance of parasitaemia and fever. The loading dose was also associated with trends to lower m ortality and higher haemoglobin levels, but these differences were not statistically significant.