[Intra-muscular artemether in the treatment of severe malaria: synthesis of current results].
Although still uncommon, resistance to quinine is being reported more and more often. Development of new drugs for treatment of severe malaria is necessary. Intramuscular artemether has been the focus of many comparative studies versus parenteral quinine with over 3,000 cases having been reported in Asia and Africa. For clearance of parasitemia current results document the greater efficacy of a five-day treatment using intramuscular artemether (2 x 80 mg on the first day and 1 x 80 mg/day for the following four days in adults and 3.2 mg/kg on the first day and 1.6 mg/kg/day for the following four days in children) as compared to the standard seven-day treatment using intravenous quinine bichlorhydrate (20 mg/kg in 4 hours then 10 mg/kg every 8 hours). In terms of survival rate, coma recovery time, incidence of neurologic sequels, and fever clearance, the two drugs gave comparable results but artemether presents a slight advantage in some cases. No adverse effects particularly neurologic manifestations have been observed. From a practical standpoint administration of intramuscular artemether is easier than administration of intravenous quinine but the overall cost of treatment is about the same. Approved and available in most countries with endemic malaria, intramuscular artemether is included in the WHO List of Essential Drugs. The indication for use only in cases of severe malaria must be strictly respected to avoid development of resistance.
Ambroise-Thomas
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Département de Parasitologie-Mycologie Médicale et Moléculaire, Relations hôte-agents pathogènes, Faculté de Médecine, Université Joseph Fourier, Grenoble, France.
D000328:Adult; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins; D002648:Child; D004351:Drug Resistance; D006801:Humans; D007262:Infusions, Intravenous; D007273:Injections, Intramuscular; D008288:Malaria / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology; D011803:Quinine / Q000627:therapeutic use*; D012107:Research Design; D012717:Sesquiterpenes / Q000494:pharmacology / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D011803:Quinine; D000077549:Artemether
L'artéméther intra-musculaire dans le traitement des paludismes graves: synthèse des résultats actuels.