Randomized Control Trial of Quinine and Artesunate in Complicated Malaria

Objective: To study the comparative efficacy of the quinine and artesunate in complicated malaria in children. Methods: All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P. falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests. Results: 80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 ± 31.49hrs; 43.55 ± 20.12 hrs, and 41.67 ± 16.78 hrs respectively) as compared to the quinine group (70.15 ± 17.56 hrs 62.23 ± 16.99 hrs, 52.24 ± 12.69 hrs respectively) (p<0.05) No side effects were observed in the artesunate treated group. Conclusion: Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution, fever clearance, parasite clearance and better tolerability.