COMPARISON OF ARTEMETHER AND QUININE IN THE TREATMENT OF SEVERE FALCIPARUM-MALARIA IN SOUTH-EAST THAILAND

One hundred and two Thai patients with severe falciparum malaria (92 m ales and 10 females) were allocated at random to receive either the st andard regimen of quinine infusion (52 cases) or intramuscular artemet her (50 cases). The patients in both groups had comparable admission c linical and laboratory data. Artemether gave a better survival rare (8 7.2% vs. 63.3%) and parasite clearance time (54 vs. 78 h) than quinine . Fever clearance times (79 h vs. 84 h) and time to recovery of consci ousness (48 h in both groups) were comparable. Previous treatment with quinine or mefloquine had no influence on treatment outcome. The most common adverse effect in patients treated with quinine was tinnitus. Two patients had severe hearing impairment which resolved within 1 wee k after the end of treatment. Mild, transient pain was noted at the in jection site of artemether but no abscess formed. QTc wave prolongatio n was seen in most patients receiving quinine; however, no arrhythmia was observed despite the high concentration of quinine in some patient s who had received quinine before admission. Complications developed i n 7 survivors in each treatment group. No patient in the artemether gr oup had neurological sequelae after recovery of consciousness, but 2 i n the quinine group had left facial palsy and one had a myasthenia gra vis-like syndrome. No patient died with complications in the artemethe r group, bur 7 died with pulmonary complications in the quinine group.