Quinine is the only drug recommended for the treatment of severe malaria throughout Africa, South America, and most of Asia. But even with prompt administration of the drug in maximum doses mortality from severe malaria remains high. Intravenous artesunate is more rapidly acting, in terms of parasite clearance, is safer, and is simpler to administer than intravenous quinine. However, whether the drug could reduce mortality was unclear.
Nick White (Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand) and colleagues recruited 1461 patients with severe malaria from Bangladesh, Indonesia, India, and Myanmar into a randomised controlled trial comparing artesunate with quinine. Half the patients were assigned intravenous artesunate and half intravenous quinine. The investigators found that mortality from severe malaria was 15% in artesunate recipients compared with 22% in quinine recipients.
Professor White concludes: "Our findings in this large multicentre trial show that parenteral artesunate reduces mortality in patients with severe malaria by over a third compared with quinine… Unfortunately, despite 20 years of use in east Asia, there is still no generally available formulation of parenteral artesunate made to Good Manufacturing Practices standards. Quality assured, affordable parenteral artesunate should be made widely available in malaria endemic areas as a matter of urgency."
Contact: Professor Nicholas J White, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Rd, Bangkok 10400, Thailand. T) +66 2 354 9172 nickw@tropmedres.ac
Website from 27.8.05; www.seaquamat.info
Journal
The Lancet