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Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial.

Dondorp, Arjen M., Nosten, Francois, Stepniewska, Kasia, Day, Nicholas P. J., White, Nicholas J. and SEAQUAMAT (South East Asian Quinine Artesunate Malaria Trial) Group (2005). Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial.. The Lancet,366(9487):717-725.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 11
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Title Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial.
Author Dondorp, Arjen M.
Nosten, Francois
Stepniewska, Kasia
Day, Nicholas P. J.
White, Nicholas J.
SEAQUAMAT (South East Asian Quinine Artesunate Malaria Trial) Group
Journal Name The Lancet
Publication Date 2005
Volume Number 366
Issue Number 9487
ISSN 0140-6736   (check CDU catalogue open catalogue search in new window)
Start Page 717
End Page 725
Total Pages 9
Place of Publication United Kingdom
Publisher The Lancet Publishing Group
Field of Research 1199 - Other Medical and Health Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract BACKGROUND: In the treatment of severe malaria, intravenous artesunate is more rapidly acting than intravenous quinine in terms of parasite clearance, is safer, and is simpler to administer, but whether it can reduce mortality is uncertain. METHODS: We did an open-label randomised controlled trial in patients admitted to hospital with severe falciparum malaria in Bangladesh, India, Indonesia, and Myanmar. We assigned individuals intravenous artesunate 2.4 mg/kg bodyweight given as a bolus (n=730) at 0, 12, and 24 h, and then daily, or intravenous quinine (20 mg salt per kg loading dose infused over 4 h then 10 mg/kg infused over 2-8 h three times a day; n=731). Oral medication was substituted when possible to complete treatment. Our primary endpoint was death from severe malaria, and analysis was by intention to treat. FINDINGS: We assessed all patients randomised for the primary endpoint. Mortality in artesunate recipients was 15% (107 of 730) compared with 22% (164 of 731) in quinine recipients; an absolute reduction of 34.7% (95% CI 18.5-47.6%; p=0.0002). Treatment with artesunate was well tolerated, whereas quinine was associated with hypoglycaemia (relative risk 3.2, 1.3-7.8; p=0.009). INTERPRETATION: Artesunate should become the treatment of choice for severe falciparum malaria in adults.
Keywords falciparum
Malaria
Quinine
DOI http://dx.doi.org/10.1016/S0140-6736(05)67176-0   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes 3644 (Journal)
 
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Created: Mon, 26 Nov 2007, 15:07:47 CST