Artemether and Quinine are Safe and Effective in The Treatment of Severe Malaria in Nigerian Children

  • O Osonuga
  • Aduragbenro Deborah Adedapo
  • Olusegun G Ademowo

Abstract

Severe malaria is a medical emergency. Parenteral artesunate is recommended over quinine for severe malaria. Artemether, is an alternative to parenteral artesunate in certain settings. The study was designed to compare the efficacy and safety of quinine with artermether using an open randomized trial in a paediatric ward of a specialist care center.  Thirty-two patients with severe malaria were randomly assigned to receive either artemether, 3.2mg/kg start and 1.6 mg/kg body weight intramuscularly daily for 4 days or quinine, 10mg/kg body weight in 5% dextrose/saline intravenously 8 hourly till recovery from coma or able to take oral dose. Patients were followed up for 14 days.  Mean fever clearance time for quinine was significantly lower when compared with artemether, (46.5 ± 20.5 versus 72.00 ± 27.7 hours; P =0.006). The malaria parasite clearance time was however significantly lower with artemether than with quinine (31.5 ± 14.5 versus 46.5 ± 6.00 hours; P=0.001).  Adverse events, including tinnitus and insomnia in quinine group were generally mild.  There was no adverse effect observed with artemether. Quinine and artemether were both effective and safe in the treatment of severe malaria in children.  Artemether was better tolerated, cleared parasite faster with earlier and sustained recovery from anaemia, jaundice and coma

References

Adam, I., Idris, H.M., Mohamed-Ali, A.A., Aelbasit, I.A., and M.I. Elbashir. 2002. Comparison of intramuscular artemether and intravenous quinine in the treatment of Sudanese children with severe falciparum malaria. East Afr Med J. 79(12):621-5.
Ademowo, O.G., Falusi, A.G., and O. O. Mewoyeka. 1995. Prevalence of asymptomatic parasitaemia in an urban and rural community in South Western Nigeria. Central African Journal of Medicine 41(1): 18-21.
Anumudu, C.I., Okafor, C.M., Ngwumohaike, V., Afolabi, K.A., Nwuba, R.I., and M. Nwagwu. 2004. Clinical manifestations and immune response to MSP1(19) in severe paediatric malaria in Adeoyo State maternity hospital, Ibadan. Afr J Med med Sci 33(1): 57-63.
Bach, O., Baier, M., Pullwitt, A., Fosiko, N., Chagaluka, G., Kalima, M., Pfister, W., Straube, E., and M. Molyneux. 2005. Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults. Trans. R Soc Trop Med Hyg 99: 861-867
Dondorp, A.M., Fanello, C.I., Hendriksen, I.C.E., Gomes, E., Seni, A., Chhanganlal, K.D., Bojang, K., Olaosebikan, R., Annumobi, N., et al., for the AQUAMAT group. 2010. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomized trial. Lancet 376:1647-1657.
Federal Ministry of Health. National Malaria Control Programme Abuja, Nigeria. 2011. National Guidelines for diagnosis and treatment of malaria. nmcpnigeria.org.
Federal Ministry of Health. National Malaria Control Programme Abuja, Nigeria. Training Manuals on Malaria. Case management of malaria in the hospital. Trainers content.
Federal Ministry of Health, Malaria Action Program for States. 2013. Treatment of severe malaria with injectable artesunate. Training workbook, Nigeria.
Huda, S.N., Shahab, T., Ali, S.M., Afzal, K., and H.M. Khan. 2003. A comparative clinical trial of artemether and quinine in children with severe malaria. Indian Pediatr. 40(10): 939-45.
Karbwang, J., NorBangchang, K., Thanavibal, A., Ditta, M., and T. Harinasuta. 1995. A comparative clinical trial of two different regimens of artemether plus mefloquinine in multidrug resistant falciparum malaria. Trans R Soc Trop Med Hyg 89;269-270.
Molyneux, M.E., Taylor, T.E., Wirima, J.J., and A. Borgstein. 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med; 71: 441-459.
Olumese, P.E., Amodu, O.K., Bjorkman, A., Adeyemo, A.A., Gbadegesin, R.A., and O. Walker. 2002. Chloroquine resistance of P.falciparum is associated with severity of disease in Nigerian children. Trans R Soc Trop Med Hyg 96: 418-420
Olumese, P.E., Bjorkman, A., Gbadegesin, R.A., Adeyemo, A.A., and O. Walker. 1999. Comparative efficacy of intramuscular artemether and intravenous quinine in Nigerian children with cerebral malaria. Acta Trop 73:231-236.
Pukrittayakamee, S., Wanwimolruk, S., Stepniewska, K., Jantra, A., Huyakorn, S., Looareesuwan, S., and N.J. White. 2003. Quinine pharmacokinetic-pharmacodynamic relationships in uncomplicated falciparum malaria. Antimicrob Agents Chemother. 47(11): 3458-63.
Rehman, M.U., Shrestha, B., Zehri, T., and S. Thapa. 2013. Efficacy of quinine versus artemether in the treatment of severe malaria. J Nepal Health Res Counc 11(23):17-21.
Sodeinde, O., Adeyemo, A.A., Gbadegesin, R.A., Olaleye, B.O., Ajayi-Obe, K.E., and O.G. Ademowo. 1996. Interaction between acute diarrhea and falciparum malaria in Nigerian children. J Diarrhoea Disease Research Dec 14(4): 369- 373.
Sowunmi, A. 1996a. Hepatomegaly in acute falciparum malaria in children. Trans R Soc Trop Med. Hyg 90: 540- 542.
Sowunmi, A. 1996b. Renal function in acute falciparum. Arch Dis child 76: 293-298.
Sowunmi, A., Ogundahunsi, O.A.T., Falade, C.O., Gbotosho, G.O., and A. M. J. Oduola. 2000. Gastro intestinal manifestations of acute falciparum in children. Acta Tropica 5; 74(1): 73-6
Sowunmi, A. and L. A. Salako. 1992. Evaluation of the relative efficacy of various antimalarial drugs in Nigeria children under 5 years of age suffering from acute uncomplicated falciparum malaria. Ann Trop Med Parasitol 86: 1-8.
White, N.J., Looareesuwan, S., and D.A. Warrell. 1982. Quinine pharmacokinetics and toxicity in cerebral and uncomplicated falciparum malaria. Am J Med 73: 564-572.
World Health Organisation. 2015. Guidelines for the treatment of malaria, 3rd edition. WHO, Geneva, Switzerland. www.who.int.
World Health Organisation. 2016. World malaria report. http://www.who.int/malaria/publications/world-malaria-report-2016/report/en. Accessed on October 3, 2017.
Published
2017-10-31
Section
Infection/Immunology/Chemotherapy