Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Use of artemether in childen as a first line drug remains to be justified.

Artemether has undoubtedly been proven to be of value in treatment of severe cerebral malaria. Similar studies using artemether in adults & children has been in Vietiman & Malawi have been reported. Animal studies have shown severe neurotoxicity in unique pattern of neuronal necrosis in brain stem nuclei. Also cerebral dysfuntion has been reported in persons treated with artesunate(similar coumpound), hence it raises ethical issues regarding its use in children. Moreover, in view of multi-drug resistance and high cost of medication in third world countries, the use of artemether as a first line drug remains to be justified.

References: 1)neurotoxicity of artemisinin analogs in vitro. journal:antimicrob agents chemother 38:1813-9,1994 publication date:1994 August Author(s):wesche DL, DeCoster MA, Tortella FC,Brewer TG.

2)A controlled trial of arthemether or quinine in vietnamese adults with severe falciparum malaria Journel:N Engl J med 335:76-83, 1996 Publication date:1996 july 11

3)Rapid coma resolution with artemether in malawian chidren with cerebral malaria journel:Lancet 341:661-2, 1993 publication date:1993 march 13

4)Artemisinin neurotoxicity Class effect:artemisinin(QHS,qinghaosu),.Artemether(AM),. Dihyroartemisinin(DHA)... johannLiang/tsld022.htm- 07-25-2002

Competing interests: None declared

Competing interests: No competing interests

13 February 2005
Sreejib Das
sho,maelor hospital, wrexham
ll13 7td