The results of an open-label, randomized trial that included 5425 children in 9 African countries suggest that intravenous artesunate should replace quinine for treating severe malaria (Dondorp AM et al for the AQUAMAT group. Lancet. 2010;376:1647-1657).
The investigators reported that 8.5% of patients taking artesunate died compared with 10.9% taking quinine. The incidence of neurological abnormalities did not differ significantly between the groups, but coma and convulsions were significantly less frequent in artesunate recipients than in quinine recipients. Posttreatment hypoglycemia was also less frequent in patients assigned to artesunate than in those assigned to quinine. In addition, no serious drug-related adverse effects were associated with artesunate.