Quinine treatment in severe Plasmodium falciparum malaria in children: a holter monitoring

Aim. Malaria has elevated incidence and mortality rate especially in African children. Standard treatment in severe Plasmodium falciparum malaria is parenteral quinine in most rural hospitals of developing countries, but little is known about the toxicity of quinine in children. Quinine has potential heart toxicity due to prolongation of the QT that could lead to the onset of dangerous ventricular arrhythmias. The aim of our work is the evaluation of cardiac toxicity of i.v. quinine in children affected by severe Plasmodium falciparum malaria. Methods. Ten children admitted to Mugana hospital (North Tanzania) affected by severe malaria, were treated with a loading dose of 20 mg/kg salt of quinine followed by 10 mg/kg every 8 hours. Holter monitoring was performed for the first 24 hours of treatment with special attention to ventricular and supraventricular arrhythmias, QT prolongation and RR variability. Results. No patient died, and treatment was well tolerated. Heart rate means ranged between 100 and 156 bpm in the population studied, with single values from 56 to 186 bpm. Minimal not significant supraventricular and ventricular arrhythmias were recorded, with no more than 6 isolated supraventricular extrasystoles and 6 supraventricular pairs of extrasystoles, and no more than 15 isolated ventricular extrasystoles. No major, life threatening ventricular arrhythmias were observed. RR analysis did not show significant fluctuations. Conclusion. These data suggest that in the pediatric African population affected by severe Plasmodium falciparum malaria quinine infusion seems to be well tolerated.