title: A trial of artemether or quinine in children with cerebral malaria.
abstract: BACKGROUND
  Cerebral malaria has a mortality rate of 10 to 30 percent despite treatment with parenteral quinine, a situation that may worsen with the spread of quinine resistance. Artemether is a new antimalarial agent that clears parasites from the circulation more rapidly than quinine, but its effect on mortality is unclear.
  
  
  METHODS
  We conducted a randomized, unblinded comparison of intramuscular artemether and intramuscular quinine in 576 Gambian children with cerebral malaria. The primary end points of the study were mortality and residual neurologic sequelae.
  
  
  RESULTS
  Fifty-nine of the 288 children treated with artemether died in the hospital (20.5 percent), as compared with 62 of the 288 treated with quinine (21.5 percent). Among the 418 children analyzed at approximately five months for neurologic disease, residual neurologic sequelae were detected in 7 of 209 survivors treated with artemether (3.3 percent) and 11 of 209 survivors treated with quinine (5.3 percent, P = 0.5). After adjustment for potential confounders, the odds ratio for death was 0.84 (95 percent confidence interval, 0.53 to 1.32) in the artemether group, and for residual neurologic sequelae, 0.51 (95 percent confidence interval, 0.17 to 1.47). There were fewer local reactions at the injection site with artemether than with quinine (0.7 percent vs. 5.9 percent, P = 0.001).
  
  
  CONCLUSIONS
  Artemether is as effective as quinine in the treatment of cerebral malaria in children.
authors.affiliation: Medical Research Council Laboratories, Fajara.
authors.forename: M B
authors.initials: MB
authors.lastname: van Hensbroek
authors.forename: E
authors.initials: E
authors.lastname: Onyiorah
authors.forename: S
authors.initials: S
authors.lastname: Jaffar
authors.forename: G
authors.initials: G
authors.lastname: Schneider
authors.forename: A
authors.initials: A
authors.lastname: Palmer
authors.forename: J
authors.initials: J
authors.lastname: Frenkel
authors.forename: G
authors.initials: G
authors.lastname: Enwere
authors.forename: S
authors.initials: S
authors.lastname: Forck
authors.forename: A
authors.initials: A
authors.lastname: Nusmeijer
authors.forename: S
authors.initials: S
authors.lastname: Bennett
authors.forename: B
authors.initials: B
authors.lastname: Greenwood
authors.forename: D
authors.initials: D
authors.lastname: Kwiatkowski
mesh_terms: D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins; D002493:Central Nervous System Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D016779:Malaria, Cerebral / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D016017:Odds Ratio; D011803:Quinine / Q000009:adverse effects / Q000627:therapeutic use*; D012717:Sesquiterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D011803:Quinine; D000077549:Artemether