Consider rectal quinine for moderately severe malaria

Rectal quinine has an acceptable safety profile in the early management of moderately severe malaria in children who cannot take oral treatment. In a randomised controlled trial by Barennes and colleagues (p 1055), almost 900 children with moderately severe Plasmodium falciparum malaria received either rectal or intramuscular quinine every 12 hours until they could take oral treatment. Although primary safety and efficacy was slightly lower in the rectal group, rectal quinine could be used in the field when injectable disposables were not available, thus guaranteeing immediate treatment.

Credit: ANDY JOHNSTONE/PANOS