Artesunate bested quinine in African children with severe malaria

Issue: December 2010

Artesunate significantly decreased mortality in African children with severe malaria when compared with quinine. These data add to previous findings suggesting artesunate should be the treatment of choice for severe malaria worldwide, according to researchers for the AQUAMAT trial.

Arjen M. Dondorp, MD, deputy director, the Mahidol-Oxford Research Unit, and faculty member of Tropical Medicine at Mahidol University in Bangkok, Thailand, presented comparison data on artesunate vs. quinine in children with severe malaria at the American Society of Tropical Medicine and Hygiene 59th Annual Meeting. The results were simultaneously published in The Lancet.

The open-label, randomized trial included 5,425 children aged younger than 15 years with severe falciparum malaria across 11 centers in nine African countries. Children were randomly assigned to parenteral artesunate (n=2,712) or parenteral quinine (n=2,713). Primary outcome measure was in-hospital mortality.

Death occurred in 10.9% of children assigned quinine compared with 8.5% of children assigned artesunate (OR=0.75; 95% CI, 0.63-0.90; relative reduction = 22.5%; 95% CI, 8.1-36.9).

Moreover, adverse events occurred less frequently in children assigned artesunate compared with children assigned quinine:

coma: 3.5% with artesunate vs. 5.1% with quinine (OR=0.69; 95% CI, 0.49-0.95);
convulsions: 8.3% vs. 10.1% (OR=0.80; 95% CI, 0.66-0.97);
post-treatment hypoglycemia: 1.8% vs. 2.8% (OR=0.63; 95% CI, 0.43-0.91);
and deterioration of the coma score: 6.1% vs. 7.7% (OR= 0.78; 95% CI, 0.64-0.97).

Overall, artesunate was well tolerated with no serious adverse effects, according to the researchers.

For more information:

Dondorp AM. Presented at: the American Society of Tropical Medicine and Hygiene 59th Annual Meeting; Nov. 3-7, 2010; Atlanta.

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