[Tolerance of quinine administered as an intrarectal solution in children in French-speaking Africa].

Pharmacokinetic studies have documented the efficacy of intrarectal quinine (IRQ) for treatment of childhood malaria. As a result, this technique has gradually supplanted intramuscular injection of quinine (IMQ), a common source of complications in children. To assess the safety of this technique, outcome was routinely monitored from 1987 to 1997. This report presents immediate tolerance observed in clinical studies involving 915 children as well as two surveys conducted in Niamey, Niger on 2764 children in 1995 and on 714 children in 1997. In the second study tolerance of IRQ (n = 364) and IMQ (n = 350) was compared. Long-term tolerance was evaluated for 11 years in a single location, i.e. Morondava, Madagascar. In 1995 IRQ accounted for 19.6 p. 100 of antimalarial treatments prescribed in Niamey. In 1997, IRQ accounted for 34.5 p. 100 of quinine prescriptions (excluding infusions) written in medical centers and 65.7 p. 100 in the Pediatric Department B of the hospital in Niamey. Overall tolerance was good, thus confirming previous clinical studies. No major and/or irreversible complication was observed. Early rejection (12.9 p. 100), intestinal transit problems (4.3 p. 100), and watery stools (12.9 p. 100) were the most common problems. In contrast, IMQ led to residual pain (3.1 p. 100), local inflammation (3.1 p. 100), abscess (0.6 p. 100), and lower extremity disability (0.3 p. 100). The precautions for use, e.g. proper dilution, and staff training requirements are reviewed in the discussion.