Quinine disposition in globally malnourished children with cerebral malaria

Abstract

Severe global malnutrition and cerebral malaria have a similar effect on quinine pharmacokinetics in children. Moderate malnutrition does not potentiate cerebral malaria-mediated modifications of quinine disposition. These results suggest that current parenteral quinine regimens can be used, unmodified, to treat children with both malaria and malnutrition.

Efficacy of Artesunate Plus Amodiaquine for Treatment of Uncomplicated Clinical Falciparum Malaria in Severely Malnourished Children Aged 6–59 Months, Democratic Republic of Congo

“…In human, Pussard and al observed that malaria and malnutrition increased plasma concentrations of quinine and reduced both the volume of distribution and the total plasma clearance [26]. Measuring the response to an acute uncomplicated Plasmodium falciparum malaria treatment with CQ, Olanrewaju WI and Johnson AW [27] observed that the proportion of children with persistence or recrudescence of parasitemia on days 4-7 and no significant reduction of parasitemia was higher among malnourished children compared to children with satisfactory nutritional status.…”

A systematic review of pharmacokinetics studies in children with protein-energy malnutrition

“…In the case of streptomycin, children with kwashiorkor exhibited an increased Vd [48] whereas children with marasmus or underweight had a decreased Vd [48]. A decreased Vd for quinine in children with undefined PEM in one study [51] was in contrast to a separate study involving children with marasmus and marasmic-kwashiorkor where the Vd was unaffected [21]. Table 4 shows the effect of PEM on the total clearance and half-life of seven drugs that are primarily metabolised in the liver.…”

Interspecies Allometric Scaling of Antimalarial Drugs and Potential Application to Pediatric Dosing

“…The scaled estimate of CL for a 15-kg child (OE) was 0.37 liter/h/kg. By comparison, the mean adult CL is 0.17 liter/h/kg (Table 3), the estimated CL based on a fixed exponent of 3/4 is 0.25 liter/h/kg, and the CL from one clinical study in children (15 kg) was 0.24 liter/h/kg (118). child doses will decrease for children with higher body weights and will also decrease as the exponent approaches unity.…”