Comparison of artesunate and quinine in the treatment of severe Plasmodium falciparum malaria at Kassala hospital, Sudan

Abstract

Introduction: There is a need to investigate the treatment (artesunate and quinine) of severe malaria, as this will influence the outcome of morbidity and the mortality of the disease.Methodology: An open randomized trial conducted at Kassala, Sudan. Patients with severe P. falciparum malaria were randomly assigned to either intravenous artesunate at 2.4 mg/kg at 0, 12, and 24 hours, then daily, or intravenous quinine at a 20 mg/kg loading dose, then 10 mg/kg three times a day. Fever and parasite clearance and coma resolution time were compared between the two groups . Results: The two groups (47 in each group) were well matched in the clinical and biochemical characteristics. Hypotension, convulsions, severe anemia, hypoglycemia, cerebral malaria, and jaundice were the predominant manifestations of severe malaria. The mean (SD) of the fever clearance (10.8 [5.5] vs. 14.0 [8.1] hours, p = 0.028) and the parasite clearance time (16.5 [6.4] vs. 21.7 [11.3] hours, p = 0.007) were significantly shorter in the artesunate-treated patients. In comatose patients, there was no difference between the two groups in coma resolution time. Following quinine infusion, ten patients developed tinnitus (p < 0.001), and four had hypoglycemia (p = 0.033). Tinnitus and hypoglycemia were not detected in the artesunate group. One patient in the artesunate group died. Conclusions: Artesunate is more effective than quinine, in term of parasite and fever clearance time, in the treatment of P. falciparum malaria in eastern Sudan. The study found no difference between artesunate and quinine in coma resolution time.

Clinical outcome of dysglycaemia in children admitted to pediatric ward at a tertiary care hospital - a prospective study

“…On the other hand, hypoglycemia is also commonly reported in children with severe malaria. Abdallah et al [21] observed hypoglycemia in 12% of adult subjects receiving intravenous quinine for severe malaria. However, Kawo et al [22] did not observe significant changes in blood glucose in subjects with falciparum malaria receiving intravenous administration of quinine.…”

Cerebral malaria

“…[3][4][5]11 In endemic areas, treatment should be started without having the confirmation of the diagnosis. 3 Pharmacological treatment against the agent 1,8,34 The intravenous administration of artemisinin derivatives, artesunate and quinine are the drugs of choice. Chloroquine has been abandoned due to resistances.…”

Red blood cell exchange in treatment of severe cerebral P. falciparum malaria: A case report

“…2 At present, artesunate and quinine have become standards of care for treatment of severe P. falciparum worldwide with artesunate becoming the preferred treatment with strong evidence for better efficacy and safety. [3][4][5] However, interest in RBC exchange transfusion as an adjunct therapy has developed due to the continued high mortality and morbidity of severe P falciparum infections. Red blood cells exchange transfusions have shown to be safe and effective in several case reports and small clinical trials.…”