Journal Article

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

Paul N. Newton, Brian J. Angus, Wirongrong Chierakul, Arjen Dondorp, Ronatrai Ruangveerayuth, Kamolrat Silamut, Pramote Teerapong, Yupin Suputtamongkol, Sornchai Looareesuwan and Nicholas J. White

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 1, pages 7-16
Published in print July 2003 | ISSN: 1058-4838
Published online July 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/375059
Randomized Comparison of Artesunate and Quinine in the Treatment of Severe Falciparum Malaria

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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.

Journal Article.  5218 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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