Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009 Jul 21:339:b2763.
doi: 10.1136/bmj.b2763.

Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

Jane Achan  1 , James K Tibenderana, Daniel Kyabayinze, Fred Wabwire Mangen, Moses R Kamya, Grant Dorsey, Umberto D'Alessandro, Philip J Rosenthal, Ambrose O Talisuna
Affiliations
Randomized Controlled Trial

Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

Jane Achan et al. BMJ. .

Abstract

Objective: To compare the effectiveness of oral quinine with that of artemether-lumefantrine in treating uncomplicated malaria in children.

Design: Randomised, open label effectiveness study.

Setting: Outpatient clinic of Uganda's national referral hospital in Kampala.

Participants: 175 children aged 6 to 59 months with uncomplicated malaria.

Interventions: Participants were randomised to receive oral quinine or artemether-lumefantrine administered by care givers at home.

Main outcome measures: Primary outcomes were parasitological cure rates after 28 days of follow-up unadjusted and adjusted by genotyping to distinguish recrudescence from new infections. Secondary outcomes were adherence to study drug, presence of gametocytes, recovery of haemoglobin concentration from baseline at day 28, and safety profiles.

Results: Using survival analysis the cure rate unadjusted by genotyping was 96% for the artemether-lumefantrine group compared with 64% for the quinine group (hazard ratio 10.7, 95% confidence interval 3.3 to 35.5, P=0.001). In the quinine group 69% (18/26) of parasitological failures were due to recrudescence compared with none in the artemether-lumefantrine group. The mean adherence to artemether-lumefantrine was 94.5% compared with 85.4% to quinine (P=0.0008). Having adherence levels of 80% or more was associated with a decreased risk of treatment failure (0.44, 0.19 to 1.02, P=0.06). Adverse events did not differ between the two groups.

Conclusions: The effectiveness of a seven day course of quinine for the treatment of uncomplicated malaria in Ugandan children was significantly lower than that of artemether-lumefantrine. These findings question the advisability of the recommendation for quinine therapy for uncomplicated malaria in Africa.

Trial registration: ClinicalTrials.gov NCT00540202.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Trial profile
None
Fig 2 Kaplan-Meier curves for risk of treatment failure with oral quinine and artemether-lumefantrine in Ugandan children with uncomplicated malaria
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization. Antimalarial drug combination therapy. Report of WHO technical consultation. WHO/CDS/RBM/2001.35. Geneva: WHO, 2001.
    1. Meshnick SR, Dobson MJ. The history of antimalarial drugs. Antimalarial chemotherapy: mechanisms of action, resistance, and new directions in drug discovery. In: Rosenthal PJ, ed. Totowa, NJ: Humana Press, 2001:15-25.
    1. World Health Organization. WHO guidelines for the treatment of malaria. WHO/HTM/MAL/2006.Geneva: WHO, 2006:1108.
    1. World Health Organization.Global antimalarial drug policies database—AFRO. Antimalarial treatment policies for P falciparum and P vivax by country in WHO Africa region. www.who.int/malaria/amdp-afro.html (accessed 9 Sep 2008).
    1. Zurovac D, Tibenderana JK, Nankabirwa J, Ssekitooleko J, Njogu NJ, Rwakimari JB, et al. Malaria case-management under artemether-lumefantrine treatment policy in Uganda. Malar J 2008;7:181. - PMC - PubMed

Publication types

Associated data