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Published on: October 11, 2019
A comparative clinical trial of artemether and quinine in children with severe malaria
1Department of Pediatrics, Jawaharlal Nehru Medical College, AMU, Aligarh, U.P. India.
Insights
Artemether offers a faster parasite and coma recovery than quinine for severe childhood malaria. While mortality rates were similar, artemether shows promise as an alternative treatment for Plasmodium falciparum malaria.
Area of Science:
- Tropical Medicine
- Pediatric Infectious Diseases
- Pharmacology
Background:
- Severe malaria in children poses a significant global health challenge.
- Plasmodium falciparum is the most lethal malaria parasite.
- Effective treatment options are crucial for reducing mortality and morbidity.
Purpose of the Study:
- To compare the efficacy of artemether versus quinine in treating severe malaria in hospitalized children.
- To evaluate clinical outcomes including mortality, parasite clearance, and neurological recovery.
Main Methods:
- An open randomized trial was conducted in a tertiary care pediatric ward.
- Children with severe malaria (WHO criteria) and P. falciparum parasitemia were randomized to receive artemether or quinine.
- Clinical status and parasite counts were monitored every 12 hours; primary endpoints were mortality and organ damage.
Main Results:
- Artemether demonstrated a significantly shorter parasite clearance time (40.9 vs. 51.9 hours) and faster recovery from coma (34.8 vs. 38.1 hours) compared to quinine.
- Overall mortality was 23.9% with no significant difference between drug groups.
- Cerebral malaria was the most frequent manifestation (76.1%); mortality reached 100% with four coexisting severe malaria manifestations.
Conclusions:
- Artemether is an effective alternative to quinine for treating severe Plasmodium falciparum malaria in children.
- Faster parasite and coma resolution with artemether suggest improved clinical management.
- The number of coexisting severe malaria manifestations is a critical determinant of mortality risk.
Objective:
To compare the efficacy of artemether and quinine in the treatment of severe malaria in hospitalized children.
Study Design:
Open randomized trial.
Setting:
Pediatric ward of a tertiary care center.
Methods:
All children admitted with clinical manifestations of severe malaria (as per WHO criteria) and asexual forms of Plasmodium falciparum demonstrated on peripheral smear were randomized to receive either artemether or quinine. Their clinical status and smears for parasite count were assessed every 12 hours until two successive blood films were negative. The primary end point of the study was death in the hospital and residual damage to the organ involved. The secondary end points were clearance of parasites and fever, length of time of recovery from coma and normal functions of the involved system.
Results:
Forty-six cases completed the study protocol, 23 assigned to each drug group. Cerebral malaria was the commonest manifestation (76.1%). Mean age in artemether versus quinine group (6.6 +/- 3.5 and 5.8 +/- 2.4 years) as well as degree of parasitemia at admission (55,800 and 60,300 per microlitre) were comparable. The overall mortality rate was 23.9% with no significant difference between the two groups. Twenty six cases (56.5%) presented with more than one manifestations of severe malaria. The mortality rate was 100% with four coexisting manifestations of severe malaria. Fever clearance time in artemether and quinine group was 44.5 and 45.9 hours respectively (P >0.05). Parasite clearance time was significantly shorter in artemether group (40.9 vs. 51.9 hours; P<0.001). Recovery from coma was shorter in artemether group (34.8 vs. 38.1 hours; P<0.05).
Conclusion:
Cerebral malaria is the most common manifestation of severe malaria in children. Artemether is a good alternative drug to quinine for P. falciparum malaria. Mortality rate is directly proportional to the number of coexisting manifestations of severe malaria.
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