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Notices to Readers Treatment of Severe Plasmodium falciparum Malaria with Quinidine Gluconate: Discontinuation of Parenteral Quinine from CDC Drug Service

CDC has recently reviewed data on the reported incidence in the United States of Plasmodium falciparum malaria and has evaluated information on the effective management of severe life-threatening infections. As a result of this review, CDC has concluded that the drug of choice in the United States for treatment of complicated P. falciparum infections is parenteral quinidine gluconate. Therefore, effective immediately, parenteral quinine dihydrochloride will no longer be available from the CDC Drug Service.

Patients with severe malaria in the United States should be treated in intensive-care facilities where central hemodynamic and electrocardiographic monitoring is available. Based on a study of patients with P. falciparum treated in the United States (1), continuous infusion of quinidine gluconate is recommended. A loading dose of 10 mg of quinidine gluconate (equivalent to 6.2 mg quinidine base) per kg of body weight is given over 1-2 hours, followed by a constant infusion of 0.02 mg quinidine gluconate per kg per minute. This regimen is highly effective and well-tolerated in monitored patients (2,3).

The Food and Drug Administration and the drug manufacturer are amending the indications for the use of quinidine gluconate to include therapy of life-threatening P. falciparum malaria.

Reasons for recommending the routine use of parenteral quinidine gluconate in the United States include the demonstrated efficacy and safety of parenteral quinidine gluconate and the unavailability of parenteral quinine that has caused delays in administering an antimalarial drug to critically ill persons. An expanded report on the use of quinidine gluconate for the treatment of P. falciparum malaria will be published in an MMWR Recommendations and Reports. Information regarding treatment of P. falciparum malaria is available from the Malaria Branch, Division of Parasitic Diseases, Center for Infectious Diseases, CDC, telephone (404) 488-4046. Reported by: Malaria Br, Div of Parasitic Diseases, Center for Infectious Diseases, CDC.


  1. Miller KD, Greenberg AE, Campbell CC. Treatment of malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion. N Engl J Med 1989;321:65-70.

  2. White NJ, Plorde JJ. Malaria. In: Wilson JD, Braunwald E, Isselbacher KJ, et al, eds. Harrison's principles of internal medicine. 12th ed. New York: McGraw-Hill, 1990.

  3. Krogstad DJ. Malaria. In: Wyngaarden JB, Smith LH, Bennett JC, Plum F, eds. Cecil's textbook of medicine. 19th ed. Philadephia: WB Saunders, 1991.

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