Rectal dihydroartemisinin versus intravenous quinine in the treatment of severe malaria: A randomised clinical trial

Objective: To compare the clinical efficacy and safety of rectal dihydroart emisinin (DATM - Cotecxin) and intravenous quinine in the treatment of seve re malaria in children and adults. Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya between July an d November 1998. Patients: A total of sixty seven patients aged two to sixty years with seve re malaria studied. Design: This was an open randomised comparative clinical trial. Outcome measures: These were parasite clearance time, fever clearance time, efficacy and the side effect profile of the two drugs. Results: The two groups were comparable on admission on the clinical and la boratory parameters. The parasite clearance time was shorter in the rectal DATM group than quinine group. There was no statistical difference on the f ever clearance time and cure rates in the two groups. The adverse reaction profile was better with rectal DATM than with quinine, tinnitus observed mo re in the quinine group. Conclusion: Rectal DATM is faster in parasite clearance than quinine and is a safe and convenient alternative to quinine in the treatment of severe ma laria.