CDC has received reports of two fatal cases of Plasmodium
falciparum malaria in the United States in which a delay in
obtaining quinidine gluconate for intravenous therapy was thought
to have played a role in the patients' deaths. Since 1991,
quinidine gluconate, a well-known and widely used class Ia
anti-arrhythmic agent, has been the only parenteral antimalarial
drug available in the United States. It is the drug of choice for
treating serious and life-threatening malaria infections and is
active against drug-resistant strains of P. falciparum. Intravenous
quinidine is indicated whenever oral therapy is not possible, in
high-density infections (greater than 5% of red blood cells
infected), and in the presence of complications such as cerebral
malaria or acute renal failure.
As newer anti-arrhythmic agents have replaced quinidine for
many of its cardiac indications, some hospitals and health
facilities have dropped quinidine gluconate from their formularies.
Although most patients with malaria reported in the United States
are treated with oral medication and recover fully, a small number
of fatal cases occur each year, often associated with substantial
delays in seeking treatment or in initiating appropriate
antimalarial therapy. Because of this potential problem, directors
of hospital drug services should take into account the essential
role of quinidine gluconate in treating patients with severe and
complicated malaria before removing it from their formularies.
Hospitals within close geographic proximity are encouraged to
coordinate their respective formularies so that quinidine gluconate
Reported by: Food and Drug Administration. Div of Parasitic
Diseases, National Center for Infectious Diseases, CDC.
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