RANDOMIZED COMPARISON OF INTRAMUSCULAR ARTEMETHER AND INTRAVENOUS QUININE IN ADULT, MELANESIAN PATIENTS WITH SEVERE OR COMPLICATED, PLASMODIUM-FALCIPARUM MALARIA IN PAPUA-NEW-GUINEA

An open-label, randomized, controlled trial was used to compare the sa fety and efficacy of intramuscular artemether (a loading dose of 3.2 m g/kg, followed by 1.6 mg/kg daily for 4 days) and intravenous quinine (a loading dose of 20 mg quinine dihydrochloride/kg, followed first by 10 mg/kg every 8 h, each injection taking 4 h, for at least 48 h, and then oral quinine for a total of 7 days) in the management of strictl y defined severe/complicated malaria in Melanesian adults. Four (12%) of the 33 patients who enrolled and completed follow-up died (one of t he 15 who received artemether and three of the 18 who received quinine ). Overall, cerebral malaria was uncommon (6%) whilst jaundice was com mon (76%). The time taken to clear 50% of parasites was less in those treated with artemether (median = 8 h; range = 2-24 h) than in the pat ients given quinine (median = 14 h; range = 2-25 h; P = 0.051). Temper ature defervescence was also quicker in those treated with artemether (median = 32 hours; range = 20-112 h) than in those in the quinine gro up (median = 48 h; range = 28-88 h; P = 0.034). Hypoglycaemia was not observed in any patient treated with artemether but complicated therap y in 11 (79%) of the 14 patients given quinine who had not had pre-tre atment spontaneous hypoglycaemia. No serious adverse effects were attr ibutable to artemether. The Plasmodium falciparum infections observed during the 1 month of follow-up, in three patients who had received ar temether and two who had been given quinine, were probably due to recr udescence. Plasmodium vivax parasitaemias were also observed during fo llow-up, in one or two patients in each treatment group. Artemether ap pears safe in Melanesian adults and is probably as effective as intrav enous quinine in the treatment of severe or complicated falciparum mal aria.