Chierakul W. Randomized comparison of artesunate and quinine in the treatment of severe falciparium malaria. Clin Infect Dis

A randomized, open-label comparison of artesunate and quinine was conducted in 113 adults with clinically severe falciparum malaria in western Thailand. Mortality was 12 % with artesunate and 22 % with quinine treatment (relative risk, 0.53; 95 % confidence interval, 0.23–1.26;). Multiple logistic regression analysisPp.22 found admission plasma lactate level, Glasgow Coma Scale score, and total serum bilirubin level to be in-dependent risk factors for death. Coma recovery and times to normalize plasma lactate levels were similar, but the parasite clearance time was much shorter among artesunate-treated patients (). Fewer patientsPp.019 became hypoglycemic during artesunate therapy (10%) than during quinine therapy (28%) (). Arte-Pp.03 sunate is at least as effective as quinine in the treatment of adults with severe malaria. Larger trials are required to determine whether mortality is reduced among patients treated with artesunate. Although many treatment trials have been conducted, no interventions have been unequivocally shown to re-duce the high mortality (12%–22%) associated with severe falciparum malaria. The conventional therapy is parenteral quinine, but this has a narrow therapeutic ratio, is associated with hyperinsulinemic hypogly