A TRIAL OF ARTEMETHER OR QUININE IN CHILDREN WITH CEREBRAL MALARIA

Background Cerebral malaria has a mortality rate of 10 to 30 percent d espite treatment with parenteral quinine, a situation that may worsen with the spread of quinine resistance. Artemether is a new antimalaria l agent that clears parasites from the circulation more rapidly than q uinine, but its effect on mortality is unclear. Methods We conducted a randomized, unblinded comparison of intramuscular artemether and intr amuscular quinine in 576 Gambian children with cerebral malaria. The p rimary end points of the study were mortality and residual neurologic sequelae. Results Fifty-nine of the 288 children treated with artemeth er died in the hospital (20.5 percent), as compared with 62 of the 288 treated with quinine (21.5 percent). Among the 418 children analyzed at approximately five months for neurologic disease, residual neurolog ic sequelae were detected in 7 of 209 survivors treated with artemethe r (3.3 percent) and 11 of 209 survivors treated with quinine (5.3 perc ent, P = 0.5). After adjustment for potential confounders, the odds ra tio for death was 0.84 (95 percent confidence interval, 0.53 to 1.32) in the artemether group, and for residual neurologic sequelae, 0.51 (9 5 percent confidence interval, 0.17 to 1.47). There were fewer local r eactions at the injection site with artemether than with quinine (0.7 percent vs. 5.9 percent, P = 0.001). Conclusions Artemether is as effe ctive as quinine in the treatment of cerebral malaria in children. (C) 1996, Massachusetts Medical Society.