Artemisinin compounds clear parasitaemia more rapidly than other drugs do in both mild and severe malaria, but no advantage in clinical efficacy has been shown. We have compared artemether treatment with standard quinine treatment in Malawian children with cerebral malaria. 65 unconscious children were randomly allocated to intravenous quinine (n = 37) or intramuscular artemether (n = 28) treatment. The two groups were well matched for various prognostic features. Median parasite clearance times were shorter in the artemether group (28 [interquartile range 18-34] vs 40 [36-44] h in the quinine group, p = 0.0002). Coma resolution times were also shorter with artemether than with quinine (8 [4-15] vs 14 [10-36] h, p = 0.01).
PIP: The antimalarials artemether and quinine were compared in 65 unconscious children with cerebral malaria treated from January to June 1992 at Queen Elizabeth Central Hospital, Blantyre, Malawi. Artemether is a derivative of the Chinese traditional remedy ginghaosu, and is chemically unrelated to quinine or other existing antimalarials. These patients had a coma score of 2 or less, peripheral Plasmodium falciparum parasitemia, and no other cause of fever or altered consciousness. They were randomized to be treated with either intravenous quinine dihydrochloride 20 mg/kg over 4 hours (37 children), then 10 mg/kg over 2 hours every 8 hours until the patient was able to drink, or artemether in in oil suspension (Rhone-Poulenc-Rorer, France) 3.2 mg/kg (28 children), then 1.6 mg/kg daily. Both groups received at least 3 doses of the drug until parasite clearance (2 consecutive 4-hourly negative screens) or recovery of consciousness. Then each received a dose of fansidar (pyrimethamine/sulphadoxine). Both parasite clearance time and time to regain consciousness (coma score of 5) were more rapid in the artemether group. Coma resolved in 8 hours in the artemether group and 14 hours in the quinine group. Outcome in terms of fever resolution time, neurological sequelae, and mortality did not differ between groups. The study was too small to compare survival: this is part of a multicenter trial to study the effect of artemether vs. quinine on mortality.