Treatment of severe falciparum malaria: quinine versus artesunate

Abstract

Background: Malaria is the most important disease of human being. More than 40% of the world’s population is considered to be at risk of exposure of this disease. Malaria  infection  has  been  increasing  over  recent  years  due  to combination  of  factors  including  increasing  resistance  of  malarial  parasite. Most of the strains of  P. falciparum  are  now  resistance  to  conventional  drugs  like chloroquine  in  many areas. The  objective of this study was to compare  the  efficacy and safety  of quinine  and  artesunate  in  treatment  of  P. falciparum  malaria.

Methods: This  is  hospital  based  prospective  study, conducted  amongst  35 randomly  selected  patients  of  severe  P. falciparum  malaria. Patients  with  any contraindications  of  either  drug  were  excluded  to  avoid  bias. Standard statistical tests were applied for qualitative as well as quantitative data.

Results: As  per  the  study  end  point  results  of  difference  of  mortality  in patients  receiving  either  drug  was  not  significant (p > 0.75), but  difference  in clinical  parameters  like  fever  clearance  time (p <0.01), parasite  clearance  time (p < 0.001) and  coma  resolution  time (p < 0.001)  were  significant  among  patients receiving  artesunate. There  were  no  any  significant  differences  in  adverse  effects of  both  the  drugs. Mortality was same in both arms taking either drug.

Conclusions: Artesunate  is  as  good  as  quinine  in  mortality  aspect  but artesunate  is  superior  in fever clearance time (FCT) &  parasite clearance time (PCT). Coma resolution time is faster with quinine as compared to artesunate. There are no significant adverse effects of either drug. So  artesunate  is  equivalent  or  superior  for  treatment  for  severe  falciparum malaria.