QUININE

Antimalarial medicine

Dosage Forms

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Tablet

300 mg

Injection

300 mg/ml (600 mg quinine in 2 ml ampoule)

Uses

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  • Uncomplicated malaria (second line alternative to dihydroartemisinin + piperaquine; first line for children <5 kg or <4 months and 1st trimester pregnancy)
  • Severe/complicated malaria (second line to IV artesunate)
  • Pre-referral treatment of severe malaria (second line to rectal artesunate)

Dose and Duration

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Uncomplicated malaria
Give every 8 hours for 7 days as in the table below:
Age Weight Dose every 8 hours
0–3 months <5 kg 10 mg/kg
3 months–1 year 5–10 kg 75 mg (=¼ tab)
1 year–5 years 10–18 kg 150 mg (=½ tab)
5 years–7 years 18–24 kg 225 mg (=¾ tab)
7 years–10 years 24–30 kg 300 mg (=1 tab)
10 years–13 years 30–40 kg 375 mg (1 ¼ tab)
13 years–15 years 40–50 kg 450 mg (=1 ½ tab)
15 years and over >50 kg 600 mg (=2 tabs)
Severe/complicated malaria; pre-referral treatment for severe malaria

10 mg/kg as IV infusion over 2–4 hours

Start new infusion every 8 hours

If IV infusion is not possible, give IM quinine 10 mg/kg every 8 hours. Use diluted solution

If IM volume required is >3 ml, give half into the front part of the right thigh and the other half into the front part of the left thigh

Once patient is able to take orally, change to a full course of artemether + lumefantrine; start 8 hours after the last quinine dose

Preparation

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  • Solution for IM injection

    Dilute to a concentration of 100 mg/ml. For example, for an ampoule of 600 mg/2 ml, add 4 ml of water for injection to get 600 mg in 6 ml (=100 mg/ml)

  • Solution for IV infusion

    Dissolve in glucose 5% or sodium chloride 0.9%.

    To prevent hypoglycaemia, preferably use glucose 5%

Contraindications

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  • Tinnitus
  • Presence of haemoglobin in urine
  • Optic neuritis

Side Effects

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  • Low blood glucose, hot flushed skin
  • Headache
  • Blurred vision
  • Itching
  • Stomach upset, bitter taste in the mouth
  • Hearing problems
  • Kidney damage
  • Irregular heartbeat

Patient Instructions

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  • Drink plenty of sugary fluids during treatment with quinine

Pregnancy

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  • Can be used

Breastfeeding

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  • Can be used

⚠️ Caution

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  • A loading dose of 20 mg/kg quinine injection is not necessary as it does not provide any significant benefits over the usual dose of 10 mg/kg
  • Do not give IM quinine in the buttocks; use the outer front part of the thigh
  • WHO recommends that quinine be given with doxycy cline when treating malaria. Doxycycline is contraindicat ed in pregnant women and children <8 years; clindamycin can be used instead
  • Do not use quinine for prophylaxis against malaria
  • If patient vomits within 1 hour of taking tablets, repeat the full dose
  • Do not give by IV injection as it is very fatal; always give as IV infusion