Efficacy of Twice Daily Quinine Regimen Versus Three Times Regimen in Treating Severe Complicated Plasmodium falciparum Malaria among Children

Malaria is a significant health problem in the tropics, with increasing morbidity and mortality. Children are the population group with the highest malaria case fatality rate. Severe. This will be the first study to investigate the efficacy of a twice-daily regimen versus the three-times daily quinine regimen in treating severe complicated Plasmodium falciparum malaria in Sudan. This was a prospective, cross-sectional, comparative hospital-based study. It was conducted in Wad Medani Pediatrics' Teaching Hospital in Gezeira state (Sudan).The study sample was divided into two groups: the first group was children who received quinine at a dose of 10 mg/kg three times a day, and the second group was those who received it at 10mg/kg twice a day. The groups were followed during their hospital stay for the differences in temperature drop, hypoglycemia, coma resolution, parasite clearance, recrudescence, and quinine side effects. 200 patients were included in this study. The mean age of presentation was 4.5 years. Fever was the most common presenting symptom in half of the patients (101 patients), 50.5%, but on examination, all the patients in the study group were febrile 100%. Low blood sugar levels were more common among the three times group in comparison with the twice daily group, 20% compared to 15% respectively on D1, 10% compared to only 2% on D2, Quinine side effects (chinqunism) were reported more frequently in quinine three times group than twice group 33% of patients of three times group developed vomiting and abdominal pain after starting of quinine on day 1,22%on D2,56 % develop tinnitus on D1,48 % on D2,38% on D3, Two patients develop transient visual loss for the 1st 2days. 20% develop tinnitus on D1,5% on D2. 19 % of patients of the times quinine group had parasite recrudescence during follow-up (appearance of symptoms of Malaria with positive blood film) two patients on day 14 and the remaining 17 patients on day 28 and the cause of this parasite recrudescence most probably was due to their poor compliance (missing the dose, stopping quinine prematurely when they felt an improvement of their children among those patients), comparing to only4 patients of twice group. Our study found no statistically significant differences between the two quinine regimens in fever remission time, parasite clearance, and coma resolution time. However, the twice-quinine regimen was associated with less chinqunism (quinine side effect) and a lower risk of hypoglycemia.