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Previous Volume 335:76-83 July 11, 1996 Number 2 Next

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ABSTRACT

Background Artemisinin (qinghaosu) and its derivatives are rapidly effective antimalarial drugs derived from a Chinese plant. Preliminary studies suggest that these drugs may be more effective than quinine in the treatment of severe malaria. We studied artemether in Vietnam, where Plasmodium falciparum has reduced sensitivity to quinine.

Methods We conducted a randomized, double-blind trial in 560 adults with severe falciparum malaria. Two hundred seventy-six received intramuscular quinine dihydrochloride (20 mg per kilogram of body weight followed by 10 mg per kilogram every eight hours), and 284 received intramuscular artemether (4 mg per kilogram followed by 2 mg per kilogram every eight hours). Both drugs were given for a minimum of 72 hours.

Results There were 36 deaths in the artemether group (13 percent) and 47 in the quinine group (17 percent; P = 0.16; relative risk of death in the patients given artemether, 0.74; 95 percent confidence interval, 0.5 to 1.11). The parasites were cleared more quickly from the blood in the artemether group (mean, 72 vs. 90 hours; P<0.001); however, in this group fever resolved more slowly (127 vs. 90 hours, P<0.001), the time to recovery from coma was longer (66 vs. 48 hours, P = 0.003), and the hospitalization was longer (288 vs. 240 hours, P = 0.005). Quinine treatment was associated with a higher risk of hypoglycemia (relative risk, 2.7; 95 percent confidence interval, 1.7 to 4.4; P<0.001), but there were no other serious side effects in either group.

Conclusions Artemether is a satisfactory alternative to quinine for the treatment of severe malaria in adults.

Source Information

From the Wellcome Trust Clinical Research Unit, Center for Tropical Diseases, Ho Chi Minh City, Vietnam (T.T.H., N.H.P., N.T.H.M., T.T.H.C., P.P.L., D.X.S., L.V.C., H.V.); and the Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom (N.P.J.D., D.W., T.E.A.P., N.J.W.).

Address reprint requests to Dr. White at Wellcome Trust Clinical Research Unit, Center for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam.

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Artemether in Severe Malaria
Gachot B., Doyon F., Hill C., Fruchter O., Newmark A., van Hensbroek M. B., Greenwood B., Kwiatkowski D., Hien T. T., Day N. P.J., White N. J.
Extract | Full Text  
N Engl J Med 1996; 335:1922-1924, Dec 19, 1996. Correspondence

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