Comparison of the effect of combinations of parentral artemisinin derivatives (I/M artemether, I/V artesunate) plus oral mefloquine with intravenous quinine plus oral tetracycline on patients with cerebral malaria: A multicentre trial (Preliminary Report)

In order to find out the best drug combination for treatment of cerebral malaria at less equipped hospitals, 105 cases of cerebral malaria belonging to Mawlamyine, Pyin Oo Lwin and North Okkalapa hospitals were studied in a controlled trial of three regimens. (1) Intramuscular artemether total dose 480 mg plus mefloquine 750 mg in a single dose given through nasogastric tube at day 0. (2) Intravenous artesunate total dose 240 mg plus mefloquine 750 mg as in regimen 1. (3) Intravenous quinine dighdrochloride 600 mg in 180 ml infusion of dextrose saline given over 4 hours. The dose is repeated every 8 hours until the patient can swallow the tablets. Then oral quinine sulphate tablets were given 600 mg 8 hourly. Total period of quinine therapy is 7 days. Tetracycline 250 mg capsules were given 6 hourly for 7 days (started via nasogastric tube while the patient is unconscious). There was no significant difference in overall mortality rate, mean parasite clearance time, mean fever clearance time and mean time to regain consiousness between the three groups. Thus quinine-tetracycline (if necessary to supplement with artemether-mefloquine at 48 hours if the patient failed to respond to initial treatment) is suggested, as the drug of first choice for the management of cerebral malaria in Myanmar.

The Effect of oral artesunate versus quinine on patients who are resistant to chloroquine and sulfadoxine pyrimethamine

The patients who attended the out patients cllinic of Thayarwaddy Civil Hospital and North Okkalapa General Hospital were treated with chloroquine (600 mg base at days 0 and 1 and 300 mg base at day 2). To those who failed to clear the parasites at 72 hours were treated with 3 tablets of sulfadoxine pyrimethamine (each containing 500 mg sulfadoxine and 25 mg pyrimethamine). To those who failed again to clear the parasites at 72 hours were treated with one of the following drugs at alternate sequence. (1) 50 mg Artesunate tablets were given twice a day for 5 days orally. The initial dose was double. (2) Quinine sulphate tablets 600 mg 3 times per day given orally for 7 days. Total 60 patients were studied.In both groups of patients parasites were cleared at 72 hours and at day 4. The parasite clearance time and fever clearance time of the patients treated with the two different drugs were not statistically different. All patients treated with artesunate can tolerate the drug and were free from side effects that can be related to the drug. Out of 18 patients who were followed till day 28,6 patients recrudesced at days between 21 and 28. Among the patients treated with quinine 50 percent failed to complete the drug course. Out of 10 patients who were followed till day 28, one patient recrudesced at day 21. We conclude that Artesunate or quinine alone are effective but may not be useful for treatment of drug resistant malaria.

Endemic goitre in Pindaya and Falam Townships (1991-1992)

Baseline field studies including clinical and biochemical assessments on goitre had been conducted in Pindaya Township, Shan State and Falam Township, Chin State during November 1991 and March 1992. The subjects were school children of both sexes between the age of 5 to 14 years from both urban and rural areas. Clinical assessment was done on 1553 subjects from Pindaya Township and 1224 subjects from Falam Township. Moreover, 135 urine samples from Pindaya and 90 samples from Falam had been collected for laboratory analysis of iodine. 55.4 percent and 62.5 percent total goitre rates were observed in Pindaya and Falam respectively and the mean urinary iodine excretion indicated that the subjects were moderately deficient in iodine.