Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial.
OBJECTIVE
To compare the efficacy and safety of rectal artemether with intravenous quinine in the treatment of cerebral malaria in children.


METHODS
Randomised, single blind, clinical trial.


METHODS
Acute care unit at Mulago Hospital, Uganda's national referral and teaching hospital in Kampala.


METHODS
103 children aged 6 months to 5 years with cerebral malaria.


METHODS
Patients were randomised to either intravenous quinine or rectal artemether for seven days.


METHODS
Time to clearance of parasites and fever; time to regaining consciousness, starting oral intake, and sitting unaided; and adverse effects.


RESULTS
The difference in parasitological and clinical outcomes between rectal artemether and intravenous quinine did not reach significance (parasite clearance time 54.2 (SD 33.6) hours v 55.0 (SD 24.3) hours, P = 0.90; fever clearance time 33.2 (SD 21.9) hours v 24.1(SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 (SD 24.1) hours v 22.67 (SD 18.5) hours, P = 0.10; time to starting oral intake 37.9 (SD 27.0) hours v 30.3 (SD 21.1) hours, P = 0.14). Mortality was higher in the quinine group than in the artemether group (10/52 v 6/51; relative risk 1.29, 95% confidence interval 0.84 to 2.01). No serious immediate adverse effects occurred.


CONCLUSIONS
Rectal artemether is effective and well tolerated and could be used as treatment for cerebral malaria.
Aceng
Jane Ruth
JR
Department of Paediatrics and Child Health, Makerere Medical School, PO Box 7072, Kampala, Uganda.
Byarugaba
Justus S
JS
Tumwine
James K
JK
D000285:Administration, Rectal; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D016779:Malaria, Cerebral / Q000188:drug therapy*; D018512:Parasitemia / Q000188:drug therapy; D011803:Quinine / Q000008:administration & dosage* / Q000009:adverse effects; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000009:adverse effects; D016037:Single-Blind Method; D013488:Suppositories; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D013488:Suppositories; D011803:Quinine; D000077549:Artemether