Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial.

Abstract

OBJECTIVE:

To compare the efficacy and safety of rectal artemether with intravenous quinine in the treatment of cerebral malaria in children.

DESIGN:

Randomised, single blind, clinical trial.

SETTING:

Acute care unit at Mulago Hospital, Uganda's national referral and teaching hospital in Kampala.

PARTICIPANTS:

103 children aged 6 months to 5 years with cerebral malaria.

INTERVENTION:

Patients were randomised to either intravenous quinine or rectal artemether for seven days.

MAIN OUTCOME MEASURES:

Time to clearance of parasites and fever; time to regaining consciousness, starting oral intake, and sitting unaided; and adverse effects.

RESULTS:

The difference in parasitological and clinical outcomes between rectal artemether and intravenous quinine did not reach significance (parasite clearance time 54.2 (SD 33.6) hours v 55.0 (SD 24.3) hours, P = 0.90; fever clearance time 33.2 (SD 21.9) hours v 24.1(SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 (SD 24.1) hours v 22.67 (SD 18.5) hours, P = 0.10; time to starting oral intake 37.9 (SD 27.0) hours v 30.3 (SD 21.1) hours, P = 0.14). Mortality was higher in the quinine group than in the artemether group (10/52 v 6/51; relative risk 1.29, 95% confidence interval 0.84 to 2.01). No serious immediate adverse effects occurred.

CONCLUSION:

Rectal artemether is effective and well tolerated and could be used as treatment for cerebral malaria.

• Authors: Jane Ruth Aceng, Justus S Byarugaba, James K Tumwine
• Journal: BMJ (Clinical research ed.) (BMJ) Vol. 330 Issue 7487 Pg. 334 (Feb 12 2005) ISSN: 1756-1833 [Electronic] England
• PMID: 15705690 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Sesquiterpenes
• Suppositories
• Quinine
• Artemether

Topics

• Administration, Rectal
• Antimalarials (administration & dosage, adverse effects)
• Artemether
• Artemisinins (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Humans
• Infant
• Infusions, Intravenous
• Malaria, Cerebral (drug therapy)
• Parasitemia (drug therapy)
• Quinine (administration & dosage, adverse effects)
• Sesquiterpenes (administration & dosage, adverse effects)
• Single-Blind Method
• Suppositories
• Time Factors
• Treatment Outcome
• Uganda