Abstract
There is a need to investigate the treatment (artesunate and quinine) of severe malaria, as this will influence the outcome of morbidity and the mortality of the disease. An open randomized trial conducted at Kassala, Sudan. Patients with severe P. falciparum malaria were randomly assigned to either intravenous artesunate at 2.4 mg/kg at 0, 12, and 24 hours, then daily, or intravenous quinine at a 20 mg/kg loading dose, then 10 mg/kg three times a day. Fever and parasite clearance and coma resolution time were compared between the two groups . The two groups (47 in each group) were well matched in the clinical and biochemical characteristics. Hypotension, convulsions, severe anemia, hypoglycemia, cerebral malaria, and jaundice were the predominant manifestations of severe malaria. The mean (SD) of the fever clearance (10.8 [5.5] vs. 14.0 [8.1] hours, p = 0.028) and the parasite clearance time (16.5 [6.4] vs. 21.7 [11.3] hours, p = 0.007) were significantly shorter in the artesunate-treated patients. In comatose patients, there was no difference between the two groups in coma resolution time. Following quinine infusion, ten patients developed tinnitus (p < 0.001), and four had hypoglycemia (p = 0.033). Tinnitus and hypoglycemia were not detected in the artesunate group. One patient in the artesunate group died. Artesunate is more effective than quinine, in term of parasite and fever clearance time, in the treatment of P. falciparum malaria in eastern Sudan. The study found no difference between artesunate and quinine in coma resolution time.
Highlights
There is a need to investigate the treatment of severe malaria, as this will influence the outcome of morbidity and the mortality of the disease
After patients or guardians signed an informed consent form, clinical data were collected using questionnaires. Those patients with one or more of the manifestations of severe P. falciparum malaria according to the World Health Organization (WHO) criteria – cerebral malaria, convulsion, hypotension, severe anemia, jaundice, hypoglycemia and hyperparasitemia – were enrolled [13]
Hypotension, convulsions, severe anemia, hypoglycemia, cerebral malaria, and jaundice were the predominant manifestations of severe malaria in this study (Table 2)
Summary
There is a need to investigate the treatment (artesunate and quinine) of severe malaria, as this will influence the outcome of morbidity and the mortality of the disease. Patients with severe P. falciparum malaria were randomly assigned to either intravenous artesunate at 2.4 mg/kg at 0, 12, and 24 hours, daily, or intravenous quinine at a 20 mg/kg loading dose, 10 mg/kg three times a day. Fever and parasite clearance and coma resolution time were compared between the two groups. There was no difference between the two groups in coma resolution time. Conclusions: Artesunate is more effective than quinine, in term of parasite and fever clearance time, in the treatment of P. falciparum malaria in eastern Sudan. Severe malaria is one of the medical emergencies in endemic countries where, if it is not treated, results in 100% mortality. Intravenous quinine (a cinchona alkaloid), which has potentially serious adverse effects, was the treatment of choice for severe malaria. Intravenous artesunate has been recommended by the WHO as the first-line therapy for treatment of severe malaria [1]
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