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Efficacy of artemether in severe falciparum malaria in African children
1Department of Pharmacology and Therapeutics and Postgraduate Institute of Medical Research and Training, University of, Ibadan, Nigeria.
Insights
Intramuscular artemether effectively treated severe childhood malaria, including drug-resistant falciparum malaria. Artemether demonstrated rapid parasite and fever clearance with a 100% cure rate and minimal side effects.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Severe malaria remains a significant health threat in children.
- Drug resistance to common antimalarials like chloroquine and sulfadoxine-pyrimethamine complicates treatment.
- Intramuscular artemether is a potential therapeutic option.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of intramuscular artemether in children with severe malaria.
- To assess artemether's effectiveness against chloroquine-resistant and sulfadoxine-pyrimethamine-resistant Plasmodium falciparum malaria.
- To determine parasite and fever clearance times and cure rates.
Main Methods:
- A clinical study involving 144 children with severe non-cerebral malaria.
- Inclusion of children with documented chloroquine-resistant and sulfadoxine-pyrimethamine-resistant falciparum malaria.
- Monitoring of parasitaemia, fever, and adverse events post-treatment.
Main Results:
- Rapid clearance of parasitaemia (>95% within 24 hours) was observed in all treatment groups.
- Mean parasite clearance times ranged from 35.4 to 36.8 hours, and fever clearance times ranged from 15.6 to 18.6 hours.
- A 100% cure rate was achieved by day 14, with minimal side effects including injection site tenderness and transient bradycardia in a few patients.
Conclusions:
- Intramuscular artemether is a rapidly effective treatment for severe falciparum malaria in children.
- Efficacy is maintained irrespective of prior drug treatment, including resistance to chloroquine and sulfadoxine-pyrimethamine.
- Artemether demonstrated a favorable safety profile with minimal adverse events in this pediatric population.
Abstract:
The clinical efficacy of intramuscular artemether was studied in 144 children suffering from severe non cerebral malaria. Fifty-three children with chloroquine-resistant and 27 children with sulfadoxinepyrimethamine-resistant falciparum malaria were also studied. Greater than 95% of pre-treatment parasitaemia was cleared by 24 h after commencement of treatment in all groups. The parasite and fever clearance times were 35.4 +/- 8.0 and 18.6 +/- 6.3 h respectively, in children suffering from severe non cerebral malaria 36.3 +/- 7.9 and 15.6 +/- 3.8 h, respectively, in the chloroquine-resistant and 36.8 +/- 8.8 and 16.5 +/- 4.2 h, respectively, in the sulfadoxine-pyrimethamine-resistant groups. The cure rate in all groups on day 14 was 100%. Side effects following treatment were minimal and comprised pain with mild tenderness at site of injection in two children and bradycardia, on the second or third day of treatment, in another two patients. No patient had pruritus. These data suggest that artemether is rapidly effective in falciparum malaria in children irrespective of previous drug treatment and especially in chloroquine- or sulphadoxinepyrimethamine-resistant infection and in this study was without deleterious side effects.