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June 14, 1996 / 45(23);494-495
                                                                                        Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
                                                                                      Notice to Readers Availability of Parenteral Quinidine Gluconate for Treatment of Severe or Complicated Malaria                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
                                                                                      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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