Artesunate Better Than Quinine for Malaria Treatment in Africa

Known to be better in Asia; drug also lowers pediatric falciparum malaria mortality in Africa

MONDAY, Nov. 8 (HealthDay News) -- Artesunate is clearly superior to quinine for treatment of severe falciparum malaria in African children, according to research published online Nov. 8 in The Lancet to coincide with presentation at the annual meeting of the American Society for Tropical Medicine and Hygiene, held from Nov. 3 to 7 in Atlanta.

Arjen M. Dondorp, M.D., of Mahidol University in Bangkok, Thailand, and colleagues from the African Quinine Artesunate Malaria Trial study group conducted a randomized clinical trial of intramuscular artesunate versus intramuscular quinine therapy for treatment of severe falciparum malaria in 5,425 African children in nine countries. The primary measured outcome was in-hospital mortality.

In the artesunate treatment group, 8.5 percent of patients died compared with 10.9 percent of the quinine treatment group (odds ratio [OR] stratified for study site, 0.75). Although the incidence of later neurological sequelae was not significantly different between treatment groups, there was a significantly lower incidence of coma, convulsions, and worsening coma score in the artesunate group (ORs, 0.69, 0.80, and 0.78, respectively). Hypoglycemia also occurred significantly less frequently in the artesunate group than in the quinine group (OR, 0.63). There were no serious drug-related adverse events with artesunate.

"Before this trial, concerns had been raised that artesunate might not be better than quinine in African children, whereas it clearly was in Asian patients," the authors write. "This large multicenter trial shows that artesunate substantially reduces the overall mortality of African children diagnosed with severe malaria. We recorded little heterogeneity between treatment centers in the benefit associated with artesunate, suggesting that the findings are robust."

Novartis provided artemether-lumefantrine for several of the study sites.

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