title: Randomized controlled trial of artesunate or artemether in Vietnamese adults with severe falciparum malaria.
abstract: BACKGROUND
  Both artemether and artesunate have been shown to be superior to quinine for the treatment of severe falciparum malaria in Southeast Asian adults, although the magnitude of the superiority has been greater for artesunate than artemether. These two artemisinin derivatives had not been compared in a randomized trial.
  
  
  METHODS
  A randomized double blind trial in 370 adults with severe falciparum malaria; 186 received intramuscular artesunate (2.4 mg/kg immediately followed by 1.2 mg/kg at 12 hours then 24 hours then daily) and 184 received intramuscular artemether (3.6 mg per kilogram immediately followed by 1.8 mg per kilogram daily) was conducted in Viet Nam. Both drugs were given for a minimum of 72 hours.
  
  
  RESULTS
  There were 13 deaths in the artesunate group (7 percent) and 24 in the artemether group (13 percent); P = 0.052; relative risk of death in the patients given artesunate, 0.54; (95 percent confidence interval 0.28-1.02). Parasitaemia declined more rapidly in the artesunate group. Both drugs were very well tolerated.
  
  
  CONCLUSIONS
  Intramuscular artesunate may be superior to intramuscular artemether for the treatment of severe malaria in adults.
authors.affiliation: Hospital for Tropical Diseases, 190 Ham Tu, Quan 5, Ho Chi Minh City, Vietnam. hientt@oucru.org.
authors.forename: Nguyen H
authors.initials: NH
authors.lastname: Phu
authors.forename: Phung Q
authors.initials: PQ
authors.lastname: Tuan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Day
authors.forename: Nguyen T H
authors.initials: NT
authors.lastname: Mai
authors.forename: Tran T H
authors.initials: TT
authors.lastname: Chau
authors.forename: Ly V
authors.initials: LV
authors.lastname: Chuong
authors.forename: Dinh X
authors.initials: DX
authors.lastname: Sinh
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Tran T
authors.initials: TT
authors.lastname: Hien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000302:isolation & purification; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014744:Vietnam; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D000077549:Artemether
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