NOTE It is important that therapy is initiated without delay at a district hospital but use discretion and guidelines in referring; Drug treatments assume all cases chloroquine resistant

Quinine (IV infusion) 10 mg/kg salt diluted in dextrose 5% given over 4 hours in a total volume of 5 - 10 ml/kg; followed by 10 mg/kg salt every 8 hours in adults and every 12 hours in children up to 4 doses then until the patient can swallow, then give for

Adult

Quinine (O) 600 mg (salt) every 8 hours to complete 7 days treatment.

Children

10 mg/kg (salt) as for adult

CAUTION

• The initial dose should be halved if patient had received quinine, quinidine or mefloquine during the previous 12-24 hours.

• Maintenance dose should be reduced three fold in patients with impaired renal function

• Pulse and blood pressure should be closely monitored during administration

• Rate of infusion be reduced if dysrhythmia occurs.

• Direct IV injection should NOT be given. Hypoglycaemia may occur after I.V administration of Quinine

• IM injection is less satisfactory but may be used to initiate therapy when facilities for IV infusion are NOT available.

The required dose should be divided equally between two sites (one in each anterior flight), Muscle necrosis and sterile abscesses may appear. If possible avoid IM Quinine injection.