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Cited by 1,050Malaria Research and ControlPhytochemical compounds biological activitiesHemoglobinopathies and Related Disorders

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

Open access
‡·2005·The Lancet
DOI 10.1016/s0140-6736(05)67176-0
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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.

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  • Mortality in pregnant women with severe malaria treated with either artesunate and quinine varied between 9% and 12%.

    “Mortality in pregnant women with severe malaria and treated with either artesunate and quinine varied between 9% and 12%.92”

    From Malaria in pregnancy. (2013) · cites this paper as [92]

  • Provision of emergency obstetric care is unlikely to impact upon this type of presentation.

    “Provision of emergency obstetric care is unlikely to impact upon this type of presentation. [34]”

    From Effect of Early Detection and Treatment on Malaria Related Maternal Mortality on the North-Western Border of Thailand 1986-2010 (2012) · cites this paper as [34]

    The Procedures and Results passages describe a trial of artesunate versus quinine for severe malaria. Although the baseline table includes pregnant patients, no passage addresses whether emergency obstetric care would affect this type of presentation (searched: emergency obstetric care and obstetric care in pregnancy). (LLM, conf=0.76)

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Research works printed but not linked: 3

  1. [2]2. Rashid R, Faiz MA, Rahman MR, et al. Quinine resistant falciparum malaria in Chittagong: a case report. Bangladesh J Med 2000; 11: 132-33.
  2. [12]12. China Cooperative Research Group on qinghaosu and its derivatives as antimalarials. Antimalarial studies on Qinghaosu. Chin Med J 1979; 92: 811-16.
  3. [18]18. Silamut K, Newton PN, Teja-Isavadharm P, et al. Artemether bioavailability after oral or intramuscular administration in uncomplicated falciparum malaria. Antimicrob Agents Chemother 2003; 47: 3795-98.

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Authors
‡
Affiliations
Mahidol University (TH)
Corresponding author
‡
Venue
The Lancet
Publisher
Elsevier BV
Published
2005-08
Volume
366
Issue
9487
Pages
717-725
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(05)67176-0
OpenAlex
W1673362020
Cited by
1,050
References
36
Citations by year
2026: 12 · 2025: 24 · 2024: 26 · 2023: 44 · 2022: 42 · 2021: 50 · 2020: 57 · 2019: 57 · 2018: 50 · 2017: 53 · 2016: 48 · 2015: 63 · 2014: 60 · 2013: 74 · 2012: 63
FWCI
50.82
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Wellcome Trust
  • Menzies School of Health Research
  • Charles Darwin University
  • Mahidol University
  • Faculty of Tropical Medicine, Mahidol University
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Phytochemical compounds biological activities
  • Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
Keywords
artesunate, quinine, severe falciparum malaria, malaria treatment, mortality, hypoglycemia, antimalarial drugs, parasite clearance, drug safety
MeSH terms
Artesunate, Adolescent, Antimalarials, Child, Preschool, Female, Humans, Male, Quinine, Sesquiterpenes, Survival Rate, Malaria, Falciparum, Artemisinins

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