The efficacy of artemether versus quinine in the treatment of cerebral malaria

Abstract

Cerebral malaria remains a major cause of childhood morbidity. Quinine is the drug of choice for which resistance is now emerging. A total of 77 children admitted to Khartoum Children Emergency Hospital who conform to WHO criteria of cerebral malaria were randomly allocated to receive either artemether (1.6 mg/kg body wt., repeated after 12 hrs and then daily for four days) or quinine (10 mg/kg body wt in 10 ml/kg body wt of 5% dextrose in 0.9% saline intravenously. Repeated every 8 hrs and changed to oral administration when the child was able to drink to finish seven days). Response to therapy was evaluated using fever clearance time (FCT), time of regaining consciousness (TRC) and parasite clearance time (PCT). The FCT (mean+SD), TRC and PCT for the artemether-treated group were 32 (+13) hrs, 21 (+11) hrs and 36 (+18) hrs, respectively, while for the quinine-treated group the respective figures were 36 (+18), 26 (+15) hrs and 41 (+12) hrs. The response to artemether was slightly better than that of quinine, but the differences between the two groups were not statistically significant. The outcome in terms of cure rate, neurological sequalae and case fatality was also comparable.