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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): An open-label, randomised trial
The Lancet, Volume 376, No. 9753, Year 2010
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Description
Severe malaria is a major cause of childhood death and often the main reason for paediatric hospital admission in sub-Saharan Africa. Quinine is still the established treatment of choice, although evidence from Asia suggests that artesunate is associated with a lower mortality. We compared parenteral treatment with either artesunate or quinine in African children with severe malaria. This open-label, randomised trial was undertaken in 11 centres in nine African countries. Children (<15 years) with severe falciparum malaria were randomly assigned to parenteral artesunate or parenteral quinine. Randomisation was in blocks of 20, with study numbers corresponding to treatment allocations kept inside opaque sealed paper envelopes. The trial was open label at each site, and none of the investigators or trialists, apart from for the trial statistician, had access to the summaries of treatment allocations. The primary outcome measure was in-hospital mortality, analysed by intention to treat. This trial is registered, number ISRCTN50258054. 5425 children were enrolled; 2712 were assigned to artesunate and 2713 to quinine. All patients were analysed for the primary outcome. 230 (8·5) patients assigned to artesunate treatment died compared with 297 (10·9) assigned to quinine treatment (odds ratio [OR] stratified for study site 0·75, 95 CI 0·63-0·90; relative reduction 22·5, 95 CI 8·1-36·9; p=0·0022). Incidence of neurological sequelae did not differ significantly between groups, but the development of coma (65/1832 [3·5] with artesunate vs 91/1768 [5·1] with quinine; OR 0·69 95 CI 0·49-0·95; p=0·0231), convulsions (224/2712 [8·3] vs 273/2713 [10·1]; OR 0·80, 0·66-0·97; p=0·0199), and deterioration of the coma score (166/2712 [6·1] vs 208/2713 [7·7]; OR 0·78, 0·64-0·97; p=0·0245) were all significantly less frequent in artesunate recipients than in quinine recipients. Post-treatment hypoglycaemia was also less frequent in patients assigned to artesunate than in those assigned to quinine (48/2712 [1·8] vs 75/2713 [2·8]; OR 0·63, 0·43-0·91; p=0·0134). Artesunate was well tolerated, with no serious drug-related adverse effects. Artesunate substantially reduces mortality in African children with severe malaria. These data, together with a meta-analysis of all trials comparing artesunate and quinine, strongly suggest that parenteral artesunate should replace quinine as the treatment of choice for severe falciparum malaria worldwide. The Wellcome Trust. © 2010 Elsevier Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3033534/bin/mmc1.pdf
Authors & Co-Authors
Dondorp, A. M.
Thailand, Nakhon Pathom
Mahidol University
Fanello, Caterina I.
Thailand, Nakhon Pathom
Mahidol University
Hendriksen, Ilse C.E.
Thailand, Nakhon Pathom
Mahidol University
Gomes, Ermelinda
Mozambique, Beira
Hospital Central da Beira
Seni, Amir Hussein Abubacar
Mozambique, Beira
Hospital Central da Beira
Chhaganlal, Kajal D.
Mozambique, Beira
Hospital Central da Beira
Bojang, Kalifa A.
Gambia, Banjul
Medical Research Council Laboratories Gambia
Olaosebikan, Rasaq R.
Gambia, Banjul
Medical Research Council Laboratories Gambia
Anunobi, Nkechinyere
Gambia, Banjul
Medical Research Council Laboratories Gambia
Maitland, Kathryn M.
Kenya, Kilifi
Kilifi District Hospital
Kivaya, Esther
Kenya, Kilifi
Kilifi District Hospital
Agbenyega, Tsiri E.
Ghana, Kumasi
Komfo Anokye Hospital
Nguah, Samuel Blay
Ghana, Kumasi
Komfo Anokye Hospital
Evans, Jennifer A.
Ghana, Kumasi
Komfo Anokye Hospital
Gesase, Samwel
Tanzania, Tanga
Magunga District Hospital
Kahabuka, Catherine
Tanzania, Tanga
Magunga District Hospital
Mtove, George A.
Tanzania, Tanga
Nimr-amani Centre
Nadjm, Behzad
Tanzania
Teule Designated District Hospital
Deen, Jacqueline L.
Tanzania
Teule Designated District Hospital
Mwanga-Amumpaire, Juliet A.
Uganda, Mbarara
Mbarara University of Science and Technology
Nansumba, M.
Uganda, Mbarara
Mbarara University of Science and Technology
Karema, Corine Kakizi
Rwanda, Kigali
Ministry of Health
Umulisa, Noella
Rwanda, Kigali
Ministry of Health
Uwimana, Aline
Rwanda, Kigali
Ministry of Health
Mokuolu, Olugbenga Ayodeji
Nigeria, Ilorin
University of Ilorin
Adedoyin, Olanrewaju Timothy
Nigeria, Ilorin
University of Ilorin
Johnson, Wahab Br
Nigeria, Ilorin
University of Ilorin
Tshefu, Antoinette Kitoto
Uganda
Kinshasa School of Public Health-kingasani Research Centre
Onyamboko, Marie A.
Uganda
Kinshasa School of Public Health-kingasani Research Centre
Sakulthaew, Tharisara
Thailand, Nakhon Pathom
Mahidol University
Pan-Ngum, Wirichada
Thailand, Nakhon Pathom
Mahidol University
Silamut, Kamolrat
Thailand, Nakhon Pathom
Mahidol University
Stepniewska, K. A.
Thailand, Nakhon Pathom
Mahidol University
Woodrow, Charles Jonathan
Thailand, Nakhon Pathom
Mahidol University
Bethell, Delia B.
United Kingdom, Oxford
Nuffield Department of Medicine
Wills, Bridget Ann
Viet Nam, Ho Chi Minh City
Oxford University Clinical Research Unit
Oneko, Martina
Kenya, Kisumu
Kemri-cdc Kisumu
Peto, Timothy E.A.
United Kingdom, Oxford
Nuffield Department of Medicine
Von-Seidlein, Lorenz
Australia, Darwin
Menzies School of Health Research
Day, Nichloas P.J.
Thailand, Nakhon Pathom
Mahidol University
White, Nicholas J.
Thailand, Nakhon Pathom
Mahidol University
Statistics
Citations: 41
Authors: 41
Affiliations: 16
Identifiers
Doi:
10.1016/S0140-6736(10)61924-1
ISSN:
01406736
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Case-Control Study
Study Approach
Systematic review