COMPARISON OF OUTCOME OF ARTESUNATE WITH QUININE IN CEREBRAL MALARIA; EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN PESHAWAR

Authors

  • S ZEB Department of Internal Medicine, MTI Lady Reading Hospital, Peshawar, Pakistan
  • Z MEHMOOD Department of neurology, MTI Lady Reading Hospital, Peshawar, Pakistan
  • SNU HADI Resident Internal Medicine, MTI Lady Reading Hospital, Peshawar, Pakistan
  • L ZEB Department of Gynecology and Obstetrics, MTI Lady Reading Hospital, Peshawar, Pakistan
  • S BAKHTIYAR Department of Internal Medicine, MTI Lady Reading Hospital, Peshawar, Pakistan
  • MB AWAN Department of Internal Medicine, MTI Lady Reading Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.470

Keywords:

Cerebral Malaria, Artesunate, Quinine, Comparison

Abstract

Malaria remains a tremendous health burden in tropical regions, causing up to 24.3 billion episodes of clinical illness and 0.86 million deaths in 2009, with annual death rates of up to 93% in severe malaria. This study aims to compare the outcome of artesunate with quinine in cerebral malaria. This Randomized Controlled Trial was conducted in the Department of Medicine, Lady Reading Hospital, Peshawar, from December 2021 to January 2023. This study was conducted on 102 patients with cerebral malaria aged 12 to 60 years of age of either gender. Patients were divided into two groups: group A received artesunate, while Group B received quinine for cerebral malaria. Outcome in terms of in-hospital mortality and mortality at follow-up was assessed between both groups. According to the in hospital treatment outcome, the mortality rate in group A (Artesunate) was 3 (5.9%) while 10 (19.6%) in group B (Quinine), the in hospital treatment outcome (mortality) was significantly lower in group A as compared to group B (P = 0.03). According to the outcome at follow-up, the mortality rate in group A was 4 (7.8%) while 12 (23.5%) in group B, the outcome (mortality) at follow-up was significantly lower in group A as compared to group B (P = 0.02). From our study, we conclude that the outcome in terms of in-hospital mortality was significantly lower in artesunate group as compared to quinine group (P = 0.03), and mortality at follow-up was also significantly lower in artesunate group as compared to quinine group (P = 0.02) in cerebral malaria.

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References

Aregawi, M., Cibulskis, R. E., Otten, M., and Williams, R. (2009). "World malaria report 2009," World Health Organization.

Chotivanich, K., Udomsangpetch, R., McGready, R., Proux, S., Newton, P., Pukrittayakamee, S., Looareesuwan, S., and White, N. J. (2002). Central role of the spleen in malaria parasite clearance. Journal of Infectious Diseases 185, 1538-1541.

Dai, M., Freeman, B., Bruno, F. P., Shikani, H. J., Tanowitz, H. B., Weiss, L. M., Reznik, S. E., Stephani, R. A., and Desruisseaux, M. S. (2012). The novel ETA receptor antagonist HJP-272 prevents cerebral microvascular hemorrhage in cerebral malaria and synergistically improves survival in combination with an artemisinin derivative. Life sciences 91, 687-692.

Dondorp, A. (2005). South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) group: Artesunate versus quinine for treatment of severe falciparum malaria: A randomized trial. Lancet 366, 717-725.

Dondorp, A. M., Fanello, C. I., Hendriksen, I. C., Gomes, E., Seni, A., Chhaganlal, K. D., Bojang, K., Olaosebikan, R., Anunobi, N., and Maitland, K. (2010). Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. The Lancet 376, 1647-1657.

Dondorp, A. M., Ince, C., Charunwatthana, P., Hanson, J., Kuijen, A. v., Faiz, M., Rahman, M., Hasan, M., Yunus, E. B., and Ghose, A. (2008). Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria. The Journal of infectious diseases 197, 79-84.

Eltahir, H. G., Omer, A. A., Mohamed, A. A., and Adam, I. (2010). Comparison of artesunate and quinine in the treatment of Sudanese children with severe Plasmodium falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 104, 684-686.

Gravenor, M. B., Van Hensbroek, M. B., and Kwiatkowski, D. (1998). Estimating sequestered parasite population dynamics in cerebral malaria. Proceedings of the National Academy of Sciences 95, 7620-7624.

Howard, N., Durrani, N., Sanda, S., Beshir, K., Hallett, R., and Rowland, M. (2011). Clinical trial of extended-dose chloroquine for treatment of resistant falciparum malaria among Afghan refugees in Pakistan. Malaria journal 10, 1-9.

Ilett, K. F., Batty, K. T., Powell, S. M., Binh, T. Q., Thu, L. T. A., Phuong, H. L., Hung, N. C., and Davis, T. M. (2002). The pharmacokinetic properties of intramuscular artesunate and rectal dihydroartemisinin in uncomplicated falciparum malaria. British journal of clinical pharmacology 53, 23-30.

Kakar, Q., Khan, M., and Bile, K. (2010). Malaria control in Pakistan: new tools at hand but challenging epidemiological realities. EMHJ-Eastern Mediterranean Health Journal, 16 (Supp.), 54-60, 2010.

Khan, S. J., Shah, N., and Ali, M. (2011). Efficacy of loading versus standard doses of quinine in cerebral malaria. RMJ 36, 86-8.

Li, Q., and Weina, P. (2010). Artesunate: the best drug in the treatment of severe and complicated malaria. Pharmaceuticals 3, 2322-2332.

Lubell, Y., Yeung, S., Dondorp, A., Day, N., Nosten, F., Tjitra, E., Abul Faiz, M., Bin Yunus, E., Anstey, N., and Mishra, S. (2009). Cost‐effectiveness of artesunate for the treatment of severe malaria. Tropical Medicine & International Health 14, 332-337.

Mithwani, S., Aarons, L., Kokwaro, G. O., Majid, O., Muchohi, S., Edwards, G., Mohamed, S., Marsh, K., and Watkins, W. (2004). Population pharmacokinetics of artemether and dihydroartemisinin following single intramuscular dosing of artemether in African children with severe falciparum malaria. British journal of clinical pharmacology 57, 146-152.

Murphy, S., Mberu, E., Muhia, D., English, M., Crawley, J., Waruiru, C., Lowe, B., Newton, C., Winstanley, P., and Marsh, K. (1997). The disposition of intramuscular artemether in children with cerebral malaria; a preliminary study. Transactions of the Royal Society of Tropical Medicine and Hygiene 91, 331-334.

Murphy, S., Watkins, W., Bray, P., Lowe, B., Winstanley, P., Peshu, N., and Marsh, K. (1995). Parasite viability during treatment of severe falciparum malaria: differential effects of artemether and quinine. The American journal of tropical medicine and hygiene 53, 303-305.

Nealon, C., Dzeing, A., Müller-Römer, U., Planche, T., Sinou, V., Kombila, M., Kremsner, P. G., Parzy, D., and Krishna, S. (2002). Intramuscular bioavailability and clinical efficacy of artesunate in gabonese children with severe malaria. Antimicrobial agents and chemotherapy 46, 3933-3939.

Silamut, K., Newton, P. N., Teja-Isavadharm, P., Suputtamongkol, Y., Siriyanonda, D., Rasameesoraj, M., Pukrittayakamee, S., and White, N. J. (2003). Artemether bioavailability after oral or intramuscular administration in uncomplicated falciparum malaria. Antimicrobial agents and chemotherapy 47, 3795-3798.

Tamarat, R., Silvestre, J.-S., Durie, M., and Levy, B. I. (2002). Angiotensin II angiogenic effect in vivo involves vascular endothelial growth factor-and inflammation-related pathways. Laboratory investigation 82, 747-756.

Tariq, M., Saleem, T., Ullah, H., Mehraj, V., Samdani, A. J., Kazmi, S. H., Ayaz, S. I., Riaz, M., Patel, M. J., and Beg, M. A. (2011). Efficacy and safety of quinine loading dose in patients with severe Falciparum malaria at a tertiary care hospital in Pakistan. Journal of the Pakistan Medical Association 61, 27.

Terkuile, F., White, N., Holloway, P., Pasvol, G., and Krishna, S. (1993). Plasmodium falciparum: in vitro studies of the pharmacodynamic properties of drugs used for the treatment of severe malaria. Experimental parasitology 76, 85-95.

Udomsangpetch, R., Pipitaporn, B., Krishna, S., Angus, B., Pukrittayakamee, S., Bates, I., Suputtamongkol, Y., Kyle, D., and White, N. (1996). Antimalarial drugs reduce cytoadherence and rosetting of Plasmodium falciparum. Journal of Infectious Diseases 173, 691-698.

Yasinzai, M. I., and Kakarsulemankhel, J. K. (2009). Prevalence of human malaria infection in bordering areas of East Balochistan, adjoining with Punjab: Loralai and Musakhel. JPMA. The Journal of the Pakistan Medical Association 59, 132-135.

Yasinzai, M. I., and Kakarsulemankhel, J. K. (2013). Prevalence of human malaria infection in Pakistani areas bordering with Iran. JPMA. The Journal of the Pakistan Medical Association 63, 313-316.

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Published

2023-10-17

How to Cite

ZEB, S., MEHMOOD, Z., HADI, S., ZEB, L., BAKHTIYAR, S., & AWAN, M. (2023). COMPARISON OF OUTCOME OF ARTESUNATE WITH QUININE IN CEREBRAL MALARIA; EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN PESHAWAR. Biological and Clinical Sciences Research Journal, 2023(1), 470. https://doi.org/10.54112/bcsrj.v2023i1.470