Comparative Efficacy of Quinine and Artesunate in the Treatment of Severe Malaria:A Randomized Controlled Trial

ABSTRACT

There is a paucity of head to head studies of quinine and artesunate in Indian patients. A consensus on the best treatment for severe malaria is lacking. To compare the efficacy of quinine and artesunate in severe falciparum malaria. This is a prospective randomized controlled, opened-labeled trial, conducted in a tertiary care center in western India. Thiry-five patients above the age of 18 years, with asexual forms of plasmodium falciparum in the peripheral smear and satisfying the WHO criteria for severe malaria, formed the study population. On randomization 18 received quinine and 17 artesunate. The end points of the study were parasite clearance time (PCT), fever clearance time (FCT), coma resolution time (CRT), adverse effects of the drugs and death. The FCT (p 0.023) and PCT (p=0.04) were lower with artesunate. The CRT was lower with quinine (p 0.03). One patient in each arm succumbed to the illness (p 0.96). There was no side effect warranting a crossover to the other arm. Thus, quinine is as good as artesunate in the treatment of severe falciparum malaria.