Comparison of chloroquine with artesunate in the treatment of cerebral malaria in Ghanaian children

Despite previously reported chloroquine-resistant forms of P. falciparum in Ghana, chloroquine remains the drug of choice in severe malaria. Artemisin in derivatives have been shown to be effective against chloroquine-resistan t strains in other endemic areas. This open randomized study was conducted to compare the efficacy of chloroquine and artesunate in the treatment of c hildhood cerebral malaria. Out of 82 subjects that fulfilled the inclusion criteria, 36 were randomized to receive chloroquine and 46 to receive artem isinin. Blantyre coma scores, temperature and parasitaemia were monitored. Mortality and neurological deficits were documented. There was no differenc e in mortality rates (chloroquine, 16.7 per cent; artesunate, 21.7 per cent ;p = 0.6), neurological deficit at day 14 (chloroquine, 0 per cent; artesun ate, 4.3 per cent; p = 0.3), resolution of fever (p = 0.55), and coma recov ery time (p = 0.8), between the two groups. The results suggest that syrup chloroquine and intramuscular/oral artesunate currently give comparable cli nical responses in the treatment of cerebral malaria in Ghana, Possible rea sons for this are discussed, and suggestions are made for future antimalari al drug policy.