title: Efficacy of sublingual lorazepam versus intrarectal diazepam for prolonged convulsions in Sub-Saharan Africa.
abstract: In Sub-Saharan Africa, intrarectal diazepam is the first-line anticonvulsant mostly used in children. We aimed to assess this standard care against sublingual lorazepam, a medication potentially as effective and safe, but easier to administer. A randomized controlled trial was conducted in the pediatric emergency departments of 9 hospitals. A total of 436 children aged 5 months to 10 years with convulsions persisting for more than 5 minutes were assigned to receive intrarectal diazepam (0.5 mg/kg, n = 202) or sublingual lorazepam (0.1 mg/kg, n = 234). Sublingual lorazepam stopped seizures within 10 minutes of administration in 56% of children compared with intrarectal diazepam in 79% (P < .001). The probability of treatment failure is higher in case of sublingual lorazepam use (OR = 2.95, 95% CI = 1.91-4.55). Sublingual lorazepam is less efficacious in stopping pediatric seizures than intrarectal diazepam, and intrarectal diazepam should thus be preferred as a first-line medication in this setting.
authors.affiliation: Service of Child Neurology, Kinshasa University Teaching Hospital, Democratic Republic of Congo ckaputukalalamalu@yahoo.fr.
authors.forename: Célestin Kaputu Kalala
authors.initials: CK
authors.lastname: Malu
authors.affiliation: Service of Child Neurology, Kinshasa University Teaching Hospital, Democratic Republic of Congo.
authors.forename: Daniel Mukeba
authors.initials: DM
authors.lastname: Kahamba
authors.affiliation: Service of Internal Medicine, Butare University Teaching Hospital, Rwanda.
authors.forename: Timothy David
authors.initials: TD
authors.lastname: Walker
authors.affiliation: Service of Pediatrics, Butare University Teaching Hospital, Rwanda.
authors.forename: Caritas
authors.initials: C
authors.lastname: Mukampunga
authors.affiliation: School of Public health, Kinshasa University Teaching Hospital, Democratic Republic of Congo.
authors.forename: Eric Mafuta
authors.initials: EM
authors.lastname: Musalu
authors.affiliation: School of Public health, Kinshasa University Teaching Hospital, Democratic Republic of Congo.
authors.forename: Jacques
authors.initials: J
authors.lastname: Kokolomani
authors.affiliation: Service of Neurology, St Joseph Hospital, Mons, Belgium.
authors.forename: Richard Mukendi Kavulu
authors.initials: RM
authors.lastname: Mayamba
authors.affiliation: Department of Pediatric Neurology, Red Cross Children's Hospital, School of Child and Adolescent Health, University of Cape Town, South Africa.
authors.forename: Jo M
authors.initials: JM
authors.lastname: Wilmshurst
authors.affiliation: Service of Paediatrics and Child Neurology, CHR Citadelle Hospital and CHU University Hospital, University of Liège, Belgium.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Dubru
authors.affiliation: Service of Paediatrics and Child Neurology, CHR Citadelle Hospital and CHU University Hospital, University of Liège, Belgium.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Misson
mesh_terms: D000285:Administration, Rectal; D000286:Administration, Sublingual; D017954:Africa South of the Sahara; D000927:Anticonvulsants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D010100:Oxygen / Q000378:metabolism; D012640:Seizures / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D008140:Lorazepam; D003975:Diazepam; D010100:Oxygen
keywords: Africa; Sublingual Lorazepam; children; convulsions; emergency treatment