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Rectal Quinine and Risk of hypoglycemia
- Prasanta Padhan (7 May 2006)
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Re: Rectal Quinine and Risk of hypoglycemia
- Hubert Barennes, Eric Pussard (10 May 2006)
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Prasanta Padhan, MD, SENIOR RESIDENT IN INTERNAL MEDICINE JIPMER,PONDICHERRY,INDIA.605006
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Dear Editor, The study by Barennes et al shows that quinine given by the rectal route has an acceptable safety profile and could be used in the early management of moderately severe malaria in children(1).But hypoglycemia is a common side effect of quinine therapy, especially in children.The safety profile of quinine in this regard has not been mentioned in this study.The risk of hypoglycemia can be theoritically higher in patients receiving rectal quinine as drug level may be higher in portal circulation and hence stimulating pancreatic beta-cell insulin secretion directly. Reference: (1)Barennes H,Balima-Koussoubé T,Nagot N, Charpentier JC, and Pussard E.Safety and efficacy of rectal compared with intramuscular quinine for the early treatment of moderately severe malaria in children: randomised clinical trial. BMJ 2006 332: 1055-1059. Competing interests: None declared |
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Hubert Barennes, Epidemiologist Institut Francophone pour la Medecine Tropicale BP 9519 Vientiane Lao P.D.R, Eric Pussard
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Dear Editor, We agree with Prasanta Padhan that hypoglycaemia resulting of quinine induced hyperinsulinaemia is a side effect of quinine therapy. We assumed that the risk of hypoglycaemia is very similar after rectal or intramuscular quinine for the following reasons. We demonstrated that rectal administration of doses of 16 or 20 mg/kg of body weight led to similar concentration times profiles to 12 mg/kg intramuscularly (1). During the study parents were asked to report any side-effects occurring after quinine administration. None of the parents in both rectal and intramuscular groups reported any signs which could be related to hypoglycaemia such as sudden intense sweating, dizziness or confusion occurring after the quinine administration. This confirms previous observations of the field studies and the hospital based studies with rectal quinine conducted in Congo, Niger, Burkina Faso, Madagascar, Senegal, Mali (more than 3000 patients). Symptomatic hypoglycaemia may be relatively rare in children with moderately severe malaria as recently shown by Ladhani et al (2) and Wooddrow et al(3). The occurrence of hypoglyceamia during quinine treatment might be prevent by appropriate replenishment of glucose either by oral route in conscious children or by sublingual administration in children unable to swallow as recently shown in moderately hypoglycaemic children (4). H.Barennes and E.Pussard Reference (1) Pussard E, Straczek C, Kabore I, Bicaba A, Balima-Koussoube T, Bouree P, et al. Dose-dependent resorption of quinine after intrarectal administration to children with moderate Plasmodium falciparum malaria. Antimicrob Agents Chemother 2004 Nov;48(11):4422-6. (2) Ladhani S, Patel VS, El Bashir H, Shingadia D. changes in laboratory features of 192 children with imported falciparum malaria treated with quinine. Pediat infec Dis J 2005;24 (11):1017-19. (3) Woodrow JC, Planche T, Krishna S. Artesunate versus quinine for severe falciparum malaria. The Lancet 2005, 367;110-111. (4) Barennes H, Valea I, Nagot N, Pussard E. Sublingual sugar as an alternative to intravenous dextrose to correct hypoglycaemia in children in the tropics. Pediatrics 2005;116(5):648-53. Competing interests: None declared |
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