The effect of mefloquine-artemether compared with quinine on patients with complicated falciparum malaria.

30 pairs of patients with complicated Plasmodium falciparum malaria (with anaemia, hyperpyrexia, jaundice or more than 5% of erythrocytes parasitized) were studied. Patients with cerebral signs and symptoms were excluded. One group of patients was treated with oral mefloquine (750 mg) and artemether (600 mg by injection, 200 mg initially and 100 mg every 12 h). The second group of patients was treated with quinine (10 mg/kg orally every 8 h for 7 d). All patients were admitted to hospital for 7 d and examined subsequently on days 14, 21 and 28. All those treated with mefloquine plus artemether survived and their parasite clearance time and fever clearance time were significantly shorter than those of patients receiving quinine. 2 patients treated with quinine died. There was no recrudescence in any patient of either group.

The combined use of artemether, sulfadoxine and pyrimethamine in the treatment of uncomplicated falciparum malaria.

29 male patients (14 from Taunggyi, 6 from Rangoon and 9 from Tharrawaddy in Burma) were treated simultaneously with 200 mg artemether (Single intramuscular dose), 1500 mg sulfadoxine and 75 mg [corrected] pyrimethamine (orally). The mean parasite clearance time was 106.7 +/- 48.7 h. Side effects were few and self-limiting. 13 of 29 patients had recrudescences before day 28; as all the patients were living in towns, reinfection was unlikely. This parasite clearance time was longer than that in patients treated with artemether alone (600 mg total dose), and the recrudescence rate was higher. This drug combination is not recommended for patients in areas where sulfadoxine/pyrimethamine resistance is already established.

A case of black water fever treated with peritoneal dialysis and artemether (quinghaosu derivative).

A clinical case of Black Water Fever following Plasmodium falciparum infection is reported. The patient had no previous history of malaria and had not taken anti-malarials as prophylasis. He was free from G-6-PD deficiency and abnormal haemoglobins. He had acute intravascular haemolysis, haemoglobinurea and renal failure after the third dose of quinine infusion. His life was saved by peritoneal dialysis and Artemether injection. In in vitro test, his blood haemolysed suddenly in 36 hours when incubated with quinine (10 mg per lit) at 37 degrees C in test tube while control blood took over a week for natural slow haemolysis. Thus quinine plays an important part in the cause of Black Water Fever.

Controlled trial of initial slow intravenous quinine vs conventional quinine infusion in the treatment of highly parasitized falciparum malaria in adult patients.

A total of 10 patients (adults) with highly parasitized falciparum malaria were treated initially with intravenous quinine (10 mg per kg quinine diluted in 20 ml normal saline injected very slowly with a syringe taking not less than 20 minutes). Six control patients were treated with quinine infusion standard method (quinine 10 mg/kg diluted in 500 ml of normal saline given as slow drip taking 4 hours for the drug to enter the patient's body). Both two groups of patients were followed by oral quinine 10 mg/kg three times a day for 7 days.

A controlled clinical trial of artemether (qinghaosu derivative) versus quinine in complicated and severe falciparum malaria.

31 pairs of patients with complicated falciparum malaria (with anaemia, jaundice, raised blood urea, hyperpyrexia or more than 2% of erythrocytes parasitized) were treated with artemether or quinine. All patients in the artemether group survived but 2 of those treated with quinine died. Fever clearance time and parasite clearance time of patients treated with artemether were significantly shorter than in the quinine-treated group. One patient who failed to respond to quinine within 72 h was saved with artemether. Follow-up of the patients showed that 9 of 23 (39.1%) recrudesced on day 28 in the artemether group. In the quinine group the recrudescence rate was 9% (2 of 22). Hence artemether may be considered as one of the drugs of choice for severely ill patients; it may even be better than quinine.

The efficacy of artemether (qinghaosu) in Plasmodium falciparum and P. vivax in Burma.

Seven sulfadoxine-pyrimethamine resistant Plasmodium falciparum infected patients and 2 patients with mixed (P. falciparum and P. vivax) infection were given Artemether. The results showed that Artemether is effective in sulfadoxine-pyrimethamine resistant malaria. The mean fever clearance time and parasite clearance time of patients treated with Artemether is shorter than those treated with chloroquine, quinine or sulfadoxine/pyrimethamine. In one patient with mixed infection all parasites disappeared but P. vivax reappeared on day 11 and on day 14 after two consecutive courses. In another P. vivax reappeared on day 21.