Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial

doi:10.1136/bmj.330.7487.334

BMJ 2005;330:334 (12 February), doi:10.1136/bmj.330.7487.334

Paper

Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial

Jane Ruth Aceng, registrar¹, Justus S Byarugaba, senior consultant¹, James K Tumwine, associate professor¹

¹ Department of Paediatrics and Child Health, Makerere Medical School, PO Box 7072, Kampala, Uganda

Corresponce to: J K Tumwine jtumwine{at}imul.com

Objective To compare the efficacy and safety of rectal artemetherwith intravenous quinine in the treatment of cerebral malariain children.

Design Randomised, single blind, clinical trial.

Setting Acute care unit at Mulago Hospital, Uganda's nationalreferral and teaching hospital in Kampala.

Participants 103 children aged 6 months to 5 years with cerebralmalaria.

Intervention Patients were randomised to either intravenousquinine or rectal artemether for seven days.

Main outcome measures Time to clearance of parasites and fever;time to regaining consciousness, starting oral intake, and sittingunaided; and adverse effects.

Results The difference in parasitological and clinical outcomesbetween rectal artemether and intravenous quinine did not reachsignificance (parasite clearance time 54.2 (SD 33.6) hours v55.0 (SD 24.3) hours, P = 0.90; fever clearance time 33.2 (SD21.9) hours v 24.1(SD 18.9 hours, P = 0.08; time to regainingconsciousness 30.1 (SD 24.1) hours v 22.67 (SD 18.5) hours,P = 0.10; time to starting oral intake 37.9 (SD 27.0) hoursv 30.3 (SD 21.1) hours, P = 0.14). Mortality was higher in thequinine group than in the artemether group (10/52 v 6/51; relativerisk 1.29, 95% confidence interval 0.84 to 2.01). No seriousimmediate adverse effects occurred.

Conclusion Rectal artemether is effective and well toleratedand could be used as treatment for cerebral malaria.

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Rapid Responses:

Read all Rapid Responses

Use of artemether in childen as a first line drug remains to be justified.: Sreejib Das
bmj.com, 13 Feb 2005 [Full text]
Artemether based combination therapy for Cerebral Malaria: Omar Aftab, et al.
bmj.com, 13 Feb 2005 [Full text]
Another evidence why the firstline drugs should be changed!: Dr. Wayengera Misaki
bmj.com, 16 Feb 2005 [Full text]
Question for authors: Desiree Lie
bmj.com, 16 Feb 2005 [Full text]
Artemether in cerebral malaria: Prem Lochan Prasad
bmj.com, 16 Feb 2005 [Full text]
Good study: Louis Nyende
bmj.com, 15 Feb 2007 [Full text]