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Objective: To compare the efficacy and safety of rectal artemether with intrav enous quinine in the treatment of cerebral malaria in children. Design: Randomis ed, single blind, clinical trial. Setting: Acute care unit at Mulago Hospital, U ganda’s national referral and teaching hospital in Kampala. Participants: 103 ch ildren aged 6 months to 5 years with cerebral malaria. Intervention: Patients we re randomised to either intravenous quinine or rectal artemether for seven days. Main outcome measures: Time to clearance of parasites and fever; time to regain ing consciousness, starting oral intake, and sitting unaided; and adverse effects. Results: The difference in parasitological and clinical outco mes between rectal artemether and intravenous quinine did not reach significance (parasite clearance time 54.2 (SD 33.6) hours v 55.0 (SD 24.3) hours, P = 0.90; fever clearance time 33.2 (SD 21.9) hours v 24.1(SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 (SD 24.1) hours v 22.67 (SD 18.5) hours, P = 0.1 0; time to starting oral intake 37.9 (SD 27.0) hours v 30.3 (SD 21.1) hours, P = 0.14). Mortality was higher in the quinine group than in the artemether group ( 10/52 v 6/51; relative risk 1.29, 95%confidence interval 0.84 to 2.01). No seri ous immediate adverse effects occurred. Conclusion: Rectal artemether is effecti ve and well tolerated and could be used as treatment for cerebral malaria.
Objective: To compare the efficacy and safety of rectal artemether with intrav enous quinine in the treatment of cerebral malaria in children. Design: Randomis ed, single blind, clinical trial. Setting: Acute care unit at Mulago Hospital, U ganda’s national referral and teaching hospital in Kampala. Participants: 103 ch ildren aged 6 months to 5 years with cerebral malaria. Intervention: Patients we re randomized to either intravenous quinine or rectal artemether for seven days. Main outcome measures: Time to clearance of parasites and fever; time to Results: The difference in parasitological and clinical outco mes between rectal artemether and intravenous quinine did not reach significance (parasite clearance time 54.2 (SD 33.6) hours v 55.0 (SD 24.3) hours P = 0.90; fever clearance time 33.2 (SD 21.9) hours v 24.1 (SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 Mortality was higher in the quinine group than in the artemether group (10: 2.67 (SD 18.5) hours, P = 0.1 0; time to starting oral intake 37.9 (SD 27.0) hours v 30.3 / 52 v 6/51; relative risk 1.29, 95% confidence interval 0.84 to 2.01). No serious immediate adverse effects occurred. Conclusion: Rectal artemether is effecti ve and well tolerated and could be used as treatment for cerebral malaria.