Randomized Comparison of Artesunate and Quinine in the Treatment of Severe Falciparum Malaria | Zendy

Paul N. Newton | Zendy; Brian Angus | Zendy; Wirongrong Chierakul | Zendy; Arjen M. Dondorp | Zendy; Ronatrai Ruangveerayuth | Zendy; Kamolrat Silamut | Zendy; Pramote Teerapong | Zendy; Yupin Suputtamongkol | Zendy; Sornchai Looareesuwan | Zendy; Nicholas J. White | Zendy

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Randomized Comparison of Artesunate and Quinine in the Treatment of Severe Falciparum Malaria

Author(s) -

Paul N. Newton,

Brian Angus,

Wirongrong Chierakul,

Arjen M. Dondorp,

Ronatrai Ruangveerayuth,

Kamolrat Silamut,

Pramote Teerapong,

Yupin Suputtamongkol,

Sornchai Looareesuwan,

Nicholas J. White

Publication year - 2003

Publication title -

clinical infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 3.44

H-Index - 336

eISSN - 1537-6591

pISSN - 1058-4838

DOI - 10.1086/375059

Subject(s) - artesunate , quinine , medicine , malaria , plasmodium falciparum , confidence interval , coma (optics) , glasgow coma scale , randomized controlled trial , mortality rate , logistic regression , relative risk , surgery , immunology , physics , optics

A randomized, open-label comparison of artesunate and quinine was conducted in 113 adults with clinically severe falciparum malaria in western Thailand. Mortality was 12% with artesunate and 22% with quinine treatment (relative risk, 0.53; 95% confidence interval, 0.23-1.26; P=.22). Multiple logistic regression analysis found admission plasma lactate level, Glasgow Coma Scale score, and total serum bilirubin level to be independent risk factors for death. Coma recovery and times to normalize plasma lactate levels were similar, but the parasite clearance time was much shorter among artesunate-treated patients (P=.019). Fewer patients became hypoglycemic during artesunate therapy (10%) than during quinine therapy (28%) (P=.03). Artesunate is at least as effective as quinine in the treatment of adults with severe malaria. Larger trials are required to determine whether mortality is reduced among patients treated with artesunate.

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