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

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:334

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Artemether based combination therapy for Cerebral Malaria

EDITOR- Jane Ruth Aceng’s article1 on the efficacy of rectal artemether for cerebral malaria in children is a useful revelation. There have been reports of delayed parasite clearance in cerebral malaria with quinine2. Under such circumstances rectal artemether is a perfect choice either alone or in combination .Various studies corroborate this finding with intramuscular artemether.It is much easier to administer a drug per rectally in children especially in third world settings where IV administration can be a problem.Artemether is not available as rectal suppositories in Pakistan but multinational brands would not be affordable for a population like ours.

Artemether is also a valuable drug in areas like Sudan where resistance to P. falciparum is growing3. The side effect profile of artemether is also minimal4.

In our opinion random blood sugar evaluation should have been done before labeling children as having cerebral malaria as in this study children with normal CSF were assumed to have only cerebral malaria. Overall the findings of this study will go a long way in solving the problem of IV cannulation especially in children in whom locating veins is diificult.Further studies need to be done on artemesinin based combination therapy in the pediatric age group.

Fahd Khalid Syed; Omar Aftab Aga Khan University; Stadium Road Karachi Pakistan

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References: 1. Aceng JR, Byarugaba JS, Tumwine JK. Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial. Bmj 2005;330(7487):334. 2. Khan MA, Smego RA, Jr., Razi ST, Beg MA. Emerging drug--resistance and guidelines for treatment of malaria. J Coll Physicians Surg Pak 2004;14(5):319-24. 3. Adam I, Idris HM, Mohamed-Ali AA, Aelbasit IA, Elbashir MI. Comparison of intramuscular artemether and intravenous quinine in the treatment of Sudanese children with severe falciparum malaria. East Afr Med J 2002;79(12):621-5. 4. Sharma P, Swarup D, Saxena GN, Bhandari S, Sharma UB, Tuteja R. An open study to evaluate the efficacy of artemether in severe falciparum malaria. J Assoc Physicians India 1999;47(9):883-5.

Competing interests: None declared

Competing interests: No competing interests

13 February 2005
Omar Aftab
Medical Student & researcher
Fahd K. Syed
Aga Khan University Stadium Road PO Box 3500,Karachi 74800.Pakistan