Falciparum malaria in ICU

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Objectives

To study and compare the various treatment modalities and the attendant complications of Falciparum malaria with or without concomitant Vivax in the Intensive Care Unit between 1993 and 1999.

Methods

Retrospective study of patients hospitalized between 1993 and 1995 and prospectively from 1996 to 1998.

Results

See Table.

Conclusions

1) Over the period of years, early use of Quinine has given good and consistent results (10 mg/kg, up to 600 mg thrice daily for 5-10 days) and can cure all stages of Falciparum and other Plasmodia, save the hypnozoites of Vivax. 2) Parasites have developed resistance to Chloroquine, Sulfadoxine- Pyremethamine. Quinine is poorly tolerated when given after Mefloquine due to the addition of adverse effects especially those of GIT. 3) If patients who have been treated with chloroquine or other drugs, including if radical cure has been attempted, continue to spike, it is best to restart with quinine even if a species other than Falciparum is the culprit. 4) Hypoglycemia, otological complications were not really severe enough or irreversible to warrant stopping Quinine. Although ECG(QTc) or other cardiac disturbances were not seen in those group,a daily ECG is a must. 5) In severely toxic patients, a simultaneous intramuscular dose of 60 mg of Artesunate on each buttock followed by a daily dose of 60 mg for the next 5 days reduces the parasite load as it is relatively new and thereby less resistant and is an effective schizonticide. It is, however, devoid of any action on the gametocytes. This was the only other group of drugs which promised future potential for concomitant use with Quinine. 6) It is best to wait for a minimum 72 h before discontinuing quinine or switching to an alternate regime. 7) Intravenous Quinine may be used only in the most toxic and orally intolerant population. 8) Primaquine must be given in Chloroquine resistant Vivax even after usage of Quinine for radical cure.

Table 1