Efficacy of Quinine versus Artemether in the treatment of severe malaria.

BACKGROUND

For centuries Quinine has been used as very effective antimalarial drug and with advent of Artemisinin and its derivative Artemether there stands a concern about the superiority among these drugs especially in case of severe malaria in paediatric population. This study compares these drugs to explore their effectiveness.

METHODS

A randomized prospective study was conducted with a view to compare efficacy regarding fever clearance, parasitaemia clearance and coma resolution between Quinine (10 milligrams per kilogram per dose diluted in 100 ml of 10 % dextrose solution T.D.S for seven days) and Artemether (3.2 milligrams per kilogram per day I.M on the first day and 1.6 milligrams per kilogram per day from second to fifth day of treatment) among 138 children with severe malaria in Bolan Medical College, Quetta, Pakistan. Study was conducted from December 2009 to December 2011. Ethical clearance was taken from Ethical clearance committee, Bolan Medical College, Quetta, Pakistan.

RESULTS

Parasitaemia clearance was better with Artemether than Quinine. Parasitaemia clearance was 68 (98.55%) and 69 (100%) on third and fifth day respectively in Artemether group while Quinine group had 64 (92.75%) and 67 (97.1%) on third and fifth day respectively [third day [RR=0.9412 (95%CI, 0.8759-1.0113) P=0.2084 and fifth day respectively [RR=0.9571 (95%CI 0.9109-1.0058) P=0.2446]. Between 24-72 hours the coma recovery rate for Quinine and Artemether were 49 (98%) and 41 (85.41%) respectively [RR=1.1473 (95%CI 1.0141-1.298) P=0.029203 but after 72 hours of treatment the coma recovery remained 49 (98%) for quinine while it was 42 (87.5%) for artemether; RR=1.12 (95%CI 0.9993-1.2553) P=0.0568. The rapid resolution of coma with Quinine within 24 to 72 hours and after 72 hours were statistically significant than Artemether.

CONCLUSIONS

In severe paediatric malaria intravenous Quinine or intramuscular Artemether therapy does not have any statistically significant difference in terms of fever clearance but Quinine has statistically significant shorter duration of coma resolution than with Artemether therapy after 24 hours of treatment.