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Randomized control trial of quinine and artesunate in complicated malaria
Anil Kumar Mohanty1, B K Rath, R Mohanty
1Departments of Pediatrics, SCB Medical College and SVP PG Institute of Pediatrics, Cuttack, Orissa, India. ctk_suvranil@sancharnet.in
Insights
Artesunate significantly outperforms quinine in treating complicated pediatric malaria. It offers faster recovery from coma, fever, and parasite clearance with no observed side effects.
Area of Science:
- Pediatric Infectious Diseases
- Tropical Medicine
- Pharmacology
Background:
- Complicated malaria in children poses a significant health risk.
- Quinine has been a traditional treatment, but its efficacy and tolerability are debated.
- Novel antimalarial drugs are needed for improved patient outcomes.
Purpose of the Study:
- To compare the efficacy and tolerability of artesunate versus quinine in children with complicated malaria.
- To evaluate the speed of clinical and parasitological response to both treatments.
Main Methods:
- A randomized controlled trial involving 80 children with complicated Plasmodium falciparum malaria.
- Patients were assigned to receive either quinine or artesunate.
- Clinical parameters including coma resolution time (CRT), fever clearance time (FCT), and parasite clearance time (PCT) were recorded.
Main Results:
- Artesunate treatment resulted in significantly shorter CRT, FCT, and PCT compared to quinine (p<0.05).
- No adverse side effects were reported in the artesunate group.
- The study included children with common malaria presentations like fever, splenomegaly, and altered sensorium.
Conclusions:
- Artesunate demonstrates superior efficacy over quinine in managing complicated pediatric malaria.
- Artesunate offers faster resolution of critical symptoms and parasite clearance.
- Artesunate is better tolerated, making it a preferred treatment option.
Objective:
To study the comparative efficacy of the quinine and artesunate in complicated malaria in children.
Methods:
All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests.
Results:
80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 +/- 31.49 hrs; 43.55 +/- 20.12 hrs, and 41.67 +/- 16.78 hrs respectively) as compared to the quinine group (70.15 +/- 17.56 hrs, 62.23 +/- 16.99 hrs, and 52.24 +/- 12.69 hrs respectively) ( p<0.05) No side effects were observed in the artesunate treated group.
Conclusion:
Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.
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