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 hypoglycaemia is a common side effect of quinine therapy, especially in children. The risk of hypoglycaemia is theoretically higher in patients receiving rectal quinine as the drug concentrations may be higher in the portal circulation, stimulating pancreatic β cell insulin secretion directly.
Competing interests: None declared.
References
- 1.Barennes H, Balima-Koussoubé T, Nagot N, Charpentier JC, 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: 1055-9. (6 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]