This article provides information about Quinine, a common drug used for malaria treatment. It discusses its effects, absorption, metabolism, and action on the parasite. The article also highlights the importance of modern treatment procedures in severe cases.
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1 MALARIA Introduction Malaria is a disease transmitted to humans commonly byAnophelesgambiaemosquito as it is infected by the parasite, more specifically a protozoa namelyPlasmodiumvivax. Malaria is a severe disease which could lead to death of the infected person and also spreads throughout the surrounding people of the diseased person as it is a contagious disease (Lallooet al.2016). The malaria infected person could experience high fever, flu-like condition, chill and other symptoms as well (Fardet, Nazareth and Petersen 2017). In the following section the effects the medication process and the effects of the medication along with the absorption and metabolism of the medication would be discussed. Common Drug for Malaria Malaria is one of the severe diseases that can cause death also and there are five types of malaria present that can be caused by differentPlasmodiumspecies and the medication also differ by means of the type of the malaria the patient infected with. However, the most common medication for the malaria treatment is Quinine which only used for malaria treatment and it used in a combination with different drug resistant compounds as without those compounds Quinine could affect the patient’s body in various ways. The drug resistant agents used with the combination with Quinine sulfate are Doxycycline, Vybramycin, Monodox and others and these combinationsare the most common medicationfor the malariatreatment(World Health Organization 2015). Other than this single type of combination three other common medications could be used in the process of malaria treatment such as the combination of Atovaquone and Proguanil, Mefloquine and Primaquine phosphate. However, the usage of anti-malaria medicines by the patients without any doctor’s consent would be fatal as these kinds of medicines do not
2 MALARIA contain any active agent that can kill the parasite causing the disease. There are several side effects which can be caused by the Quinine use in the treatment of malaria such as nose bleed, blood in urine, higher rate of heart pounding, dizziness, chest pain and others. In order to prevent all these side effects the drug resistant compounds are used in combination of Quinine. The Quinine does not kill the parasite outside the red blood cell however, it prevents the fever and other symptoms by effecting the infected red blood cells and in this process the drug takes at least 4 weeks to cure the patient’s condition and if there is no effect then the medication must stopped. Quinine is an old drug and it does not work against severe malaria and thus the modern medication of Artemether-lumefantrine is more effective in the severe conditions (Phyoet al. 2018). Quinine Medication Quinine comes in a capsulated form and can be taken up by the oral process and the medication needed to be up taken 3 times a day after eating. Quinine absorbed by the body fluid and it has a high affinity towards the proteins and thus binds with theα-1 acid glycoprotein. However, the binding in the plasma is highly concentration dependent and also depends on the levels of theα-1 acid glycoprotein present in the body (Dziekanet al.2019). After one to three hours of absorption Quinine hits its peek and works most and the half life of the drug ranges from 11 to 18 hours. The metabolism process of the drug comprised of the attachment to theα-1 acid glycoprotein and then the cytochrome P-450 enzyme which metabolises approximately 50% of the drug in the clinical process glucose-6-phosphate dehydrogenase is also a enzyme that helps in the metabolism process of this drug as the deficiency of this enzyme found to have negative impacts on the Quinine metabolism process. The 80% of the taken drug eliminated from the body by means of the hepatic biotransformation and the 20% of Quinine excreted by the
3 MALARIA kidney in an unchanged form. This is the cause in the urine of Quinine treated patient contains 3- hydroxyquinine one of the metabolite of the Quinine formed after the metabolism process by the cytochrome p-450 enzyme (Sullivan 2017). Action of Quinine Quinine primarily acts on the erythrocytic stage of the human malaria with small amount of effect over the sporozoites, hepatic stages and also the gametocytic stage of theP. falciparum. On the other hand it also affects the asexual stage of theP. ovale, P. vivax, and P. malariae (Bairdet al.2016).It has an effect over the gametocytic stages of these species of the parasite however, the effect is very small. It has an adherence to theα-1 acid glycoprotein and it mainly interferes in the process of the digestion of the haemoglobin by the parasite and it also prevents the formation of the beta-haematin, the toxic pigment that forms after the digestion of the haemoglobin by the parasite. All these actions are occurred in the liver as the parasite after entering the body directly affects the liver cells and also attacks the red blood cell. Thus it can be seen the Quinine working on the parasite at the liver and the blood vessels in the stomach. The drug interacts with the erythrocyte membrane protein known as stomatin and binds with the parasite affected erythrocytes and prevent the action of the parasite that is digestion of the red blood cells (Mischitelliet al.2016). However, the whole process of the Quinine action is still not discovered by the scientists thus it can be said that theα-1 acid glycoprotein and the stomatin are the primary proteins that helps in the proper action of the Quinine drug. Other medicines such as Atorvastatin, Iovastatin, Dextromethorphan containing cough syrups and other are the medicines that interact and used with the Quinine in treatment of malaria. The common side effects of the drug are headache, nauseous feeling, dizziness and others.
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4 MALARIA Based on the above discussion it can be said that the Quinine is one of the old drugs that commonly used in the primary intervention of malaria. However, in severe conditions the modern process would be taken in account for the treatment. On the other hand the Quinine does not kill the parasite but prevents the action of it and this drug has several side effects on the body. Thus the modern treatment procedure would be more effective than the Quinine usage in the treatment procedure.
5 MALARIA References Baird, J.K., Valecha, N., Duparc, S., White, N.J. and Price, R.N., 2016. Diagnosis and treatment ofPlasmodiumvivaxmalaria.TheAmericanjournaloftropicalmedicineandhygiene, 95(6_Suppl), pp.35-51. Dziekan, J.M., Yu, H., Chen, D., Dai, L., Wirjanata, G., Larsson, A., Prabhu, N., Sobota, R.M., Bozdech, Z. and Nordlund, P., 2019. Identifying purine nucleoside phosphorylase as the target of quinine using cellular thermal shift assay.Science translational medicine,11(473), p.eaau3174. Fardet,L.,Nazareth,I.andPetersen,I.,2017.AssociationBetweenLong-termQuinine Exposure and All-Cause Mortality.Jama,317(18), pp.1907-1909. Lalloo, D.G., Shingadia, D., Bell, D.J., Beeching, N.J., Whitty, C.J. and Chiodini, P.L., 2016. UK malaria treatment guidelines 2016.Journal of Infection,72(6), pp.635-649. Mischitelli, M., Jemaà, M., Almasry, M., Faggio, C. and Lang, F., 2016. Stimulation of erythrocyte cell membrane scrambling by quinine.Cellular Physiology and Biochemistry,40(3- 4), pp.657-667. Phyo, A.P., Win, K.K., Thu, A.M., Swe, L.L., Htike, H., Beau, C., Sriprawat, K., Winterberg, M., Proux, S., Imwong, M. and Ashley, E.A., 2018. Poor response to artesunate treatment in two patients with severe malaria on the Thai–Myanmar border.Malaria journal,17(1), p.30. Sullivan, D.J., 2017. Quinolines block every step of malaria heme crystal growth.Proceedings of the National Academy of Sciences,114(29), pp.7483-7485. World Health Organization, 2015.Guidelines for the treatment of malaria. World Health Organization.