Rectal Artemether Versus Intravenous Quinine For The Treatment Of Cerebral Malaria In Children In Uganda: Randomised Clinical Trial

Cerebral malaria is the most severe and life threatening complication of Plasmodium falciparum malaria and carries a case fatality rate1 of 5-40%, with most deaths occurring within the first 24 hours.2 Although the recommended treatment of cerebral malaria is intravenous quinine,1 alternative drugs are necessary where intravenous treatment is not possible.3 Most studies comparing rectal artemether with intravenous quinine were carried out in adults.4–6 The results were variable, and information on the use of artemether in children is limited.6 One recent study found that a single dose of rectal artesunate is associated with rapid reduction in parasite density in children and adults with moderately severe malaria.7 If found effective, rectal artemether might be particularly useful for treating severely ill children at peripheral health units,2 where facilities for intravenous treatment are often lacking.3 8 Using rectal formulations might prevent potentially life threatening complications arising from delays in administering effective antimalarial treatment to children with cerebral malaria. We compared the efficacy and safety of rectal artemether with that of intravenous quinine in the treatment of children, aged 6 months to 5 years, with cerebral malaria.
Aceng, J. R., Byarugaba, J. S., & Tumwine, J. K. (2005). Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial. Bmj, 330(7487), 334.