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COMPARISON OF INTRAMUSCULAR ARTEMETHER AND INTRAVENOUS QUININE IN THE TREATMENT OF SUDANESE CHILDREN WITH SEVERE FALCIPARUM MALARIA
Abstract
Objectives: To compare the efficacy of intramuscular artemether and intravenous quinine
in the treatment of severe falciparum malaria.
Design: An open randomized controlled clinical trial.
Setting: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-
January 2002.
Subjects: Forty one male and female children; 21 on artemether and 20 on quinine.
Main outcome measures: Fever clearance time, parasite clearance time, coma resolution
time and side effects of the two drugs.
Results: The two groups (artemether and quinine) were well matched in the admission
variable. The mean ± (SD) fever clearance time was 30.5 ± (20.9) hours in the artemether
group, while it was 18.0± (8.1) hours in the quinine group; the difference was highly
significant (P=0.02). The mean parasite clearance time was shorter in the artemether
group than in the quinine group, but it was not statistically significant, (16.0 vs. 22.4
hours; p>0.05). In comatose patients (three in the artemether group, three in the quinine
group) the time of recovery from coma was significantly shorter in artemether group
than in quinine group (12.5 vs. 20.16 hours; P<0.05). Recrudescence of P. falciparum
(confirmed by polymerase chain reaction) occurred in one out of fifteen patients (6.6%)
in the quinine group seen on day 28, which was successfully treated by sulphadoxinepyrimethamine.
In the quinine group, one patient died and one patient developed
hypoglycaemia.
Conclusion: Artemether caused faster parasite clearance than quinine, but quinine
lowered the temperature in shorter time than artemether. The results obtained show
that artemether can be used as safe and effective alternative drug for the treatment
of severe falciparum malaria in the wake of the growing resistance to quinine in Sudan.
in the treatment of severe falciparum malaria.
Design: An open randomized controlled clinical trial.
Setting: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-
January 2002.
Subjects: Forty one male and female children; 21 on artemether and 20 on quinine.
Main outcome measures: Fever clearance time, parasite clearance time, coma resolution
time and side effects of the two drugs.
Results: The two groups (artemether and quinine) were well matched in the admission
variable. The mean ± (SD) fever clearance time was 30.5 ± (20.9) hours in the artemether
group, while it was 18.0± (8.1) hours in the quinine group; the difference was highly
significant (P=0.02). The mean parasite clearance time was shorter in the artemether
group than in the quinine group, but it was not statistically significant, (16.0 vs. 22.4
hours; p>0.05). In comatose patients (three in the artemether group, three in the quinine
group) the time of recovery from coma was significantly shorter in artemether group
than in quinine group (12.5 vs. 20.16 hours; P<0.05). Recrudescence of P. falciparum
(confirmed by polymerase chain reaction) occurred in one out of fifteen patients (6.6%)
in the quinine group seen on day 28, which was successfully treated by sulphadoxinepyrimethamine.
In the quinine group, one patient died and one patient developed
hypoglycaemia.
Conclusion: Artemether caused faster parasite clearance than quinine, but quinine
lowered the temperature in shorter time than artemether. The results obtained show
that artemether can be used as safe and effective alternative drug for the treatment
of severe falciparum malaria in the wake of the growing resistance to quinine in Sudan.
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