Life-saving rectal artesunate for complicated malaria in children.

We report the effectiveness of two regimens of rectal artesunate formulation in treating 13 Thai children with cerebral/complicated falciparum malaria. The drug was given at an initial dose of 40 mg/kg bodyweight, in 3 or 4 divided doses in the first 24 hours, followed by 10 mg/kg bodyweight once daily for three consecutive days. Mefloquine, at a dose of 15 mg/kg bodyweight was given orally at 72 hours after the initial dose of artesunate, followed by 10 mg/kg bodyweight 6 hours later. Three cases with cerebral malaria gained consciousness within 20 hours of artesunate administration. The median time required for reduction of parasitemia by 90% of the initial value (P90) in 13 children was 11.2 hours. No recrudescence was observed in any of the patients during the 28-day follow-up period. Plasma concentrations of artesunate and dihydroartemisinin (active plasma metabolite of artesunate) measured in two patients who received the high initial dose regimen (20 mg/ kg bodyweight) suggested rapid absorption and adequate plasma concentrations of both compounds following the administration of artesunate via the rectal route. Further studies for the optimized regimen of rectal artesunate in the treatment of cerebral/complicated childhood falciparum malaria in areas of multidrug resistance are warranted.

Outcome of intracranial hemorrhage in infants with congenital factor VII deficiency.

The outcome of 8 episodes of intracranial hemorrhage in 7 patients (4 males, 3 females) with congenital factor VII deficiency was evaluated. Their levels of factor VII clotting activity (FVII:C) were less than 1 per cent (n = 3) and ranged from 1.7 to 2.3 per cent (n = 4). The onset varied from the first week (n = 2), first month (n = 3), and at the ages of 6, 11 and 12 months (n = 3). The replacement therapy of 10 ml/kg of fresh frozen plasma (FFP) every 6-12 hours for 5-7 days was given to 6 patients. Only one craniotomy for the removal of hematoma was performed. The seventh patient experienced two episodes of bleeding. First, she received 20 microg/kg of recombinant factor VIIa (rFVIIa) every 6 hours for 4 days (1,200 microg) followed by FFP in one episode. Second, a craniotomy for the removal of a 7 cm diameter hematoma was performed by giving 20 microg/kg of rFVIIa every 6 hours for 12 days (9,600 microg) followed by FFP in another episode. As a result of these treatments, 2 died and 5 survived with sequelae, except for one who received rFVIIa. The sequelae included seizure disorder (n = 1) and hydrocephalus (n = 3). Subsequently, the surviving patients received 15 ml/kg of lyophilized fresh plasma every 3-5 days as prophylactic treatment. In conclusion, rFVIIa in the dose of 20 microg/kg every 6 hours has been shown to be effective in controlling intracranial hemorrhage in patients with congenital factor VII deficiency.

A study of 2 MMR vaccines in 9-12 month old infants.

The MMR vaccines licensed in Thailand, Triviraten and MMR II, were used in the present study in order to evaluating their immunogenicity and safety. The study was carried out at Paholpolpayuhasena Hospital during the period from January to August 1995. Subjects comprised 116 children which were randomly divided into 2 groups. The first group (no. = 58) received Triviraten and the second group (no. = 58) received MMR II. Seroconversion rate against measles, mumps and rubella were 94.83%, 79.31% and 96.55%, respectively in the Triviraten group, and were 84.48%, 91.38% and 98.28%, respectively in the MMR II group. The differences between the seroconversion rate of three vaccine components were of no statistical significant. The geometric mean titer for the measles (1,516.07 IU/L) and mumps (1,004.45 IU/L) strain in the MMR II group, however were significantly (P < 0.001) higher than the Triviraten group. Adverse reactions from vaccination were mild and showed no statistically significant difference between the two vaccines used.