title: Preliminary report: a comparative clinical trial of artemether and quinine in severe falciparum malaria.
abstract: Twenty-six patients with severe falciparum malaria were randomized to be treated with quinine or artemether. Twelve patients received quinine at the standard dose and fourteen patients received artemether intramuscularly at a total dose of 640 mg over 7 days. The patients were kept in the hospital for at least 7 days. Peripheral smear was performed 6-hourly until there was no parasitemia, then daily until discharged. Adverse effects were monitored through physical examination, laboratory findings and questionnaires. Laboratory examination was performed on admission, day 2, day 4 weekly until discharged. The patients in both groups were comparable in age, body weight, admission parasitemia, hemoglobin and white blood cell count. The survival rates were 93% and 58% in artemether and quinine groups, respectively (p = 0.052 at 95% confidence, using Fisher's exact test). The parasite and fever clearance times, and the time taken to gain consciousness in cerebral malaria patients were not significantly different between the two groups. Adverse effects in the quinine group consisted of dizziness and vertigo which were found in 4 patients. No adverse effects were noticed in the artemether group. This preliminary report suggests that artemether is a good alternative drug for severe falciparum malaria and seems to be better than quinine regarding survival rate and side effects. Confirmation of these findings in a larger study size is needed.
authors.affiliation: Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Karbwang
authors.forename: K
authors.initials: K
authors.lastname: Sukontason
authors.forename: W
authors.initials: W
authors.lastname: Rimchala
authors.forename: W
authors.initials: W
authors.lastname: Namsiripongpun
authors.forename: T
authors.initials: T
authors.lastname: Tin
authors.forename: P
authors.initials: P
authors.lastname: Auprayoon
authors.forename: S
authors.initials: S
authors.lastname: Tumsupapong
authors.forename: D
authors.initials: D
authors.lastname: Bunnag
authors.forename: T
authors.initials: T
authors.lastname: Harinasuta
mesh_terms: D058186:Acute Kidney Injury / Q000469:parasitology; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D011803:Quinine / Q000627:therapeutic use*; D012717:Sesquiterpenes / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D011803:Quinine; D000077549:Artemether