The efficacy of artemether versus quinine in the treatment of cerebral malaria in Sudanese children.


Research type: Research Paper

Authors: El Hassan, Sarar Hamza .

Abstract: Malaria is a major childhood problem in Sudan. Cerebral malaria is a leading cause of child mortality and morbidity. Resistance has recently developed to quinine, the drug of choic for cerebral malaria. It is therefore necessary to search for new compound for its treatment. the main objectives of this study were to determine the efficacy of a new drug i.e artemether and to compare it to quinine in the treatment of cerebral malaria. The study was hospital-based conducted at Chilren's Emergency Hospital - Khatoum and Ahmed Gasim Specalist Hospital for Children 77 children admitted with cerebral malaria (according to the WHO criteria) were randomly allocated to receive either quinine (n=39) or artemether (n=38). Atyped questionnaire was completed with history and physical examination. The majority of the patients presented with fever, convulsions and loss of consciousness. One third of the patients had hepatosplenomegaly. The response to artemether was better than that to quinine. This was demonstrated by a: more rapid coma resolution tim, b: shorter fever clearance time and c: shorter parasite clearance time. However, the differences were not statistically significant. Both artemether and quinine were well tolerated. Adverse effects were slightly more in the quinine group. The outcome, in terms of cure, case fatality and neurological sequalae was comparable in the two groups. No recrudescence was reported. Bothe quinine and artemether were safe and effective in the treatment of cerebral malaria. Artemether however, is prefered to quinine in the treatment of cerebral malaria, especially in remote areas where medical facilities are megre. It is more cost - effective, easoer to administer and required less monitoring. It is also the drug of choice in areas where quinine resistance have emerged.