title: A randomized trial of the efficacy of artesunate and three quinine regimens in the treatment of severe malaria in children at the Ebolowa Regional Hospital, Cameroon.
abstract: BACKGROUND
  Severe malaria is a medical emergency with high mortality in children below 5 years of age especially in sub-Saharan Africa. Recently, quinine has been replaced by artesunate as the first-line drug in the treatment of severe malaria in Cameroon. No local data are yet available on the efficacy of artesunate with respect to the different quinine regimens used in this setting. This study was undertaken at the Ebolowa Regional Hospital (ERH), which is located in a region of perennial transmission of malaria.
  
  
  METHODS
  This was a randomized, open-label trial in children aged 3 months to 15 years, admitted in the hospital with severe malaria due to Plasmodium falciparum confirmed on microscopy after informed parental consent. Patients were randomized into four groups. Group 1 (ARTES) received parenteral artesunate at 2.4 mg/kg at H0, H12, H24 and then once daily; Group 2 (QLD) received a loading dose of quinine base at 16.6 mg/kg followed 8 hours later by an eight-hourly maintenance dose of 8.3 mg/kg quinine base; Group 3 (QNLD3) received 8.3 mg/kg quinine base every 8 hours; and, Group 4 (QNLD2) received 12.5 mg/kg quinine base every 12 h. All patients invariably received a minimum of 24 h parenteral treatment, then, oral drugs were prescribed. The endpoints were fever clearance time, time to sit unsupported, time to eat, parasite clearance time, and parasitaemia reduction rate at H24. Survival analysis was used to compare the outcomes.
  
  
  RESULTS
  One-hundred and sixteen patients completed the study: 29 in ARTES arm, 28 in QLD arm, 30 in QNLD3 arm, and 29 in QNLD2 arm. There was no major differences in baseline characteristics in the treatment groups. On analysis of endpoints, fever clearance time and parasite clearance time were significantly shorter for artesunate-treated patients than for quinine-treated patients. Parasitaemia reduction rate at H24 was also significantly higher for artesunate. Time to sit unsupported and time to eat were shorter with artesunate, but the difference was not statistically significant.
  
  
  CONCLUSIONS
  Artesunate is more effective than quinine in the treatment of severe malaria in Cameroonian children.
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. e_makadaniel@yahoo.fr.
authors.forename: Daniel Ethe
authors.initials: DE
authors.lastname: Maka
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. andy_chiabi@yahoo.co.uk.|Paediatric Unit, Yaounde Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon. andy_chiabi@yahoo.co.uk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Chiabi
authors.affiliation: Department of Pharmacology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. ndikumvn@yahoo.com.
authors.forename: Valentine
authors.initials: V
authors.lastname: Ndikum
authors.affiliation: Case Management Section, Cameroon National Malaria Control Programme, Yaounde, Cameroon. dollykah@yahoo.com.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Achu
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. aminevelyn@yahoo.co.uk.|Paediatric Unit, Yaounde Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon. aminevelyn@yahoo.co.uk.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Mah
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. seraphin_nguefack@yahoo.fr.|Paediatric Unit, Yaounde Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon. seraphin_nguefack@yahoo.fr.
authors.forename: Séraphin
authors.initials: S
authors.lastname: Nguefack
authors.affiliation: Paediatric Unit, Ebolowa Regional Hospital, Ebolowa, Cameroon. nanouchkina@yahoo.fr.
authors.forename: Pamela
authors.initials: P
authors.lastname: Nana
authors.affiliation: Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. njoumemiz@gmail.com.
authors.forename: Zakariaou
authors.initials: Z
authors.lastname: Njoumemi
authors.affiliation: Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. wfmbacham@yahoo.com.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Mbacham
authors.affiliation: Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon. eliembondasn@yahoo.fr.|Paediatric Unit, Yaounde Gynaeco-Obstetric and Paediatric Hospital, Yaounde, Cameroon. eliembondasn@yahoo.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Mbonda
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D000077332:Artesunate; D002163:Cameroon; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D011803:Quinine / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D011803:Quinine