Artemether and Quinine are Safe and Effective in The Treatment of Severe Malaria in Nigerian Children

Abstract

Severe malaria is a medical emergency. Parenteral artesunate is recommended over quinine for severe malaria. Artemether, is an alternative to parenteral artesunate in certain settings. In this study, the efficacy and safety of quinine and artermether were compared using an open randomized trial in the paediatric ward of a specialist care center. 32 patients with severe malaria were randomly assigned to receive either artemether, 3.2mg/kg start and 1.6 mg/kg body weight intramuscularly daily for 4 days or quinine, 10mg/kg body weight in 5% dextrose/saline intravenously 8 hourly till recovery from coma or able to take oral dose. Patients were followed up for 14 days. Results: Mean fever clearance time for quinine was significantly lower when compared with artemether, (46.5 ± 20.5 versus 72.00 ± 27.7 hours; P =0.006). The malaria parasite clearance time was however significantly lower with artemether than with quinine (31.5 ± 14.5 versus 46.5 ± 6.00 hours; P=0.001). Adverse events, including tinnitus and insomnia in quinine group were generally mild. There was no adverse effect observed with artemether. Quinine and artemether were both effective and safe in the treatment of severe malaria in children. Artemether was better tolerated, cleared parasite faster with earlier and sustained recovery from anaemia, jaundice and coma.