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Volume 335:69-75 July 11, 1996 Number 2 Next

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ABSTRACT

Background Cerebral malaria has a mortality rate of 10 to 30 percent despite treatment with parenteral quinine, a situation that may worsen with the spread of quinine resistance. Artemether is a new antimalarial agent that clears parasites from the circulation more rapidly than quinine, but its effect on mortality is unclear.

Methods We conducted a randomized, unblind-ed comparison of intramuscular artemether and intramuscular quinine in 576 Gambian children with cerebral malaria. The primary end points of the study were mortality and residual neurologic sequelae.

Results Fifty-nine of the 288 children treated with artemether died in the hospital (20.5 percent), as compared with 62 of the 288 treated with quinine (21.5 percent). Among the 418 children analyzed at approximately five months for neurologic disease, residual neurologic sequelae were detected in 7 of 209 survivors treated with artemether (3.3 percent) and 11 of 209 survivors treated with quinine (5.3 percent, P = 0.5). After adjustment for potential confounders, the odds ratio for death was 0.84 (95 percent confidence interval, 0.53 to 1.32) in the artemether group, and for residual neurologic sequelae, 0.51 (95 percent confidence interval, 0.17 to 1.47). There were fewer local reactions at the injection site with artemether than with quinine (0.7 percent vs. 5.9 percent, P = 0.001).

Conclusions Artemether is as effective as quinine in the treatment of cerebral malaria in children.

Source Information

From Medical Research Council Laboratories, Fajara (M.B.H., E.O., S.J., B.G.); Sibanor Health Centre, Sibanor (G.S., S.F.); and the Department of Paediatrics, Royal Victoria Hospital, Banjul (A.P., G.E.) — all in the Gambia; the Departments of Tropical Medicine (M.B.H.) and Pediatrics (J.F., A.N.), University of Amsterdam, Academic Medical Center, Amsterdam; the Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London (S.B.); and the University Department of Paediatrics, John Radcliffe Hospital, Oxford, United Kingdom (D.K.).

Address reprint requests to Dr. Boele van Hensbroek at the Department of Tropical Medicine F4, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.

Full Text of this Article

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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.
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N Engl J Med 1996; 335:1922-1924, Dec 19, 1996. Correspondence

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