Quinine

Non-Severe Malaria Treatment in Chloroquine resistant regions
1. Combined with Doxycycline, Tetracycline or Clindamycin
2. Alternative when Artemisinin Combination Therapy (ACT) is unavailable
Do NOT use for Nocturnal Leg Cramps
1. Low efficacy and high risk

Quinidine alkaloid extracted from cinchona tree bark
Quinine inhibits Hemoglobin metabolism in Malarial blood stages (as with other antimalarials)
1. Inhibits heme polymerase activity (resulting in toxic heme accumulation)
2. Kills erythrocyte and gametocyte forms of Malaria
Quinine has been used as an antimalarial since the 1600s
1. Tonic water (soda, sugar and Quinine) was created to make the very bitter Quinine more palatable
2. Tonic water was first devised by British soldiers of 1800s in Malaria-prone regions (e.g. India)
3. Tonic water was also commonly combined with gin

Malaria
1. Combined with 7 days of Doxycycline, Tetracycline or Clindamycin
2. Adult: 648 mg salt (542 mg base) three times daily orally for 3 days (7 days in Southeast Asia)
  1. In severe Chronic Kidney Disease, after first dose, decrease to 324 mg orally every 12 hours
3. Child: 10 mg/kg up to 648 mg salt (8.3 mg/kg up to 542 mg base) three times daily orally
Severe Babesiosis
1. Combined with Clindamycin 7 to 10 mg/kg up to 600 mg IV every 6 hours for 7 to 10 days
2. Adult: 650 mg orally every 6 to 8 hours
3. Child: 8 mg/kg (up to 650 mg) orally every 8 hours