Comparison of rectal artemisinin with intravenous quinine in the treatmentof severe malaria in Ethiopia

Objective: To compare the clinical efficacy and safety of artemisinin suppo sitory with quinine injection. Design: Comparative open randomised study, Setting: A government regional referral hospital in Ethiopia, Subjects: Sixty five adult patients of both sexes: 32 for artemisinin and 3 3 for quinine with complicated severe falciparum malaria. Main outcome measures: Therapeutic responses and adverse reactions. Results: The clinical and laboratory data in both groups of patients on adm ission were comparable. The parasite clearance time (PCT), fever subsidence time (FST) and coma resolution time (CRT) were shorter in the artemisinin treated group. There was no significant different in the parasitological cu re rates in both arms of treatment. No correlation was observed between the initial parasite density and PCT or FST in both groups of treatment. Morta lity rates were similar both in the artemisinin and quinine groups. The com mon adverse effects observed in most patients receiving quinine, in an incr easing order of occurrence were; vomiting, dizziness, hypoglycaemia and tin nitus, which were all relatively rare with artemisinin. Some patients treat ed with artemisinin showed tenesmus which was not observed in any patient t reated with quinine, Conclusion: The rectal artemisinin is more efficacious and safer than the i ntravenous quinine, Thus, artemisinin may be considered a potential drug wh ich can replace quinine in the treatment of severe malaria in Ethiopia prov ided it is made available at affordable prices.