PHYSICIAN DILEMNA, QUININE DIHYDROCHLORIDE VS ARTEMISININ

Abstract

Cerebral malaria is a disease entity which we commonly come across and that itshould be suspected in every patient with impairment of conscious level and high spiking feverespecially with no history of trauma. Early treatment is crucial and can be lifesaving. There aretwo treatment option in which one is conventional Quinine Dihydrochloride and other artmisinininfusion. Objectives: To study the outcomes of Quinine dihydrochloride and artemisininpractice in patients with cerebral malaria in terms of acceptance and response. Study Design:Descriptive cohort study. Place and Duration of Study: Department of Medicine, Unit. II,Jinnah Postgraduate Medical Centre (JPMC), Karachi from January1st2015 to December 31st,2015. Methodology: A total of 78 patients fulfilled the inclusion criteria of Glasgow Coma scale(GCS) were of less than 6 for more than 6 hours Defervescence time were 2 to 3 hours afterstart of treatment Strength of our study is that patients traditional prompt response, with comamulti-organ dysfunction tends to recover and discharge in 4 days. Result: There were total of78 patient. Out of them 32 (41.0%) were positive for Malaria with 29 (37.1%) were positive forPlasmodium Falciparum and 3 were having Plasmodium Vivax .all were offered treatment with57 (73.0%) were given Quinine infusion and 21 (26.94%) were treated with artemisinin infusion.Cure rate was 44 (56.4%) with 46 (58.9%) in quinine group and 14 (17.9%) artemisinin group and(19.2%) and 07 (8.9%) respectively making total mortality of 18 (23.0%). There were 9 (11.5%)patients who left against the medical advice. Average age was 26 ±, majority were male. Inaddition laboratory derangements like alanine amino transferases (ALT), bilirubin, creatinine,electrolytes as potassium and arterial blood gases(ABGs) were also considered. It has beenestimated that recovery time of patients was maximum of 72 hours (time of discharge) for bothartimisinin and Quinine dihydrochloride. Late responders were also observed. Occasionallypersistent of treatment is needed with no fear of drugs resistance. Conclusion: Quinine infusionis generally safe and effective conventional treatment option, whose benefits and acceptance iswell known and we are also documenting this.