Abstract

COMPARATIVE EFFICACY OF QUININE AND ARTESUNATE IN THE TREATMENT OF SEVERE MALARIA IN CHILDREN: A RANDOMISED CONTROLLED TRIAL IN A TERTIARY HOSPITAL OF NORTH EAST INDIA..

Author(s): Dr. Tapash Ghosh,

BACKGROUND Around 1.5 million confirmed cases are reported annually by NVBDCP of which 50% are due to Plasmodium falciparum. Artesunate has recently replaced quinine as the first line drug for the management of severe malaria in children in WHO guidelines. There is no definite study comparing efficacy of Quinine and Artesunate in the north east region of India. This study was taken up to compare efficacy of Quinine with Artesunate in treatment of severe malaria in children. METHODS All cases up to 12 years of age admitted in the paediatric ward with clinical features of severe malaria as per WHO criteria having asexual forms of P. falciparum in peripheral smear were included in the study. Sixty-eight patients were randomized in Group A (Artemisinin) and Group Q (Quinine). On admission, detailed history and examination findings were recorded and thin and thick smears for MP, QBC assay, CBC, RBS, KFT (Kidney Function tests), serum bilirubin, chest x-ray (CXR), LFT, urine analysis, CSF analysis in cerebral malaria cases were done and repeated as per protocol. In Group A, patients received Artesunate and in Group Q, patients received Quinine and all aspects of supportive treatment as per WHO guidelines. The outcome measures were in-hospital mortality, FCT, PCT, CRT, mean hospital stay, residual neurological deficits and drug toxicity in both the arms. RESULTS Mean FCT, mean PCT, mean CRT, mean hospital stay were significantly less in the Artesunate arm. But mortality and residual neurological deficit at 28 days and drug toxicities did not differ significantly between the arms. CONCLUSIONS Artesunate is a better choice over quinine for the population of this part of India.