People with severe malaria are unconscious, have difficulty breathing, may convulse, and have low blood sugar. They need treating quickly.
Quinine given intravenously or intramuscularly has been used for some years to treat severe malaria. It is particularly helpful as it works against parasites resistant to chloroquine, which used to be an effective and commonly used drug.
The World Health Organization recommends that doctors give people with severe malaria an initial high dose (loading dose) of intravenous quinine followed by lower quinine maintenance doses. This is to get an effective drug concentration in the blood. Several different quinine loading doses, maintenance doses, and dose intervals have been examined. There are some concerns about adverse effects in children.
The authors of this review wanted to summarize the benefits and harms of different quinine dosing regimens. They identified four relevant trials with 144 participants. A high initial dose of quinine reduced fever clearance time and parasite clearance time, but there were too few data to describe the impact on death. No difference was detected for recovery of consciousness and other neurological symptoms, but there were probably too few participants to detect differences.