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 sulphadoxine-pyrimethamine. 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.