1Dr Maria Gulnaz, 2Dr. Usman Khan, 3Dr Uroosa Khan, 4Dr. Alia Abdulhaq
1AP Paediatrics, MMC General Hospital Peshawar
2Peadiatric Medical Officer, District Head Quarter Hospital Batkhela
3Medical Officer, Pediatric Critical Care, Lady Reading Hospital, MTI Peshawar
4Post Graduate Resident, Lady Reading Hospital, Peshawar
Correspondence: Dr. Maria Gulnaz, AP Paediatrics, MMC General Hospital Peshawar
Abstract
Background: Malaria is still a global concern despite the development in different fields and continues to make children below the age of 5 years suffer in regions such as sub-Saharan Africa. Clinically the most severe form of malaria is cerebral malaria, which is mainly due to P. falciparum and has to be treated effectively without delay. Earlier, intravenous quinine had been used for the treatment of this disease, however, intravenous artesunate has recently been identified as potent contender on quicker reaction time and least side effects.
Aim: This study will compare the efficacy of intravenous quinine and intravenous artesunate in paediatric cerebral malaria in order to determine which one has better results in a particular group of children.
Method: This study was a randomized control trial in the Department of Pediatric Medicine, Lady Reading Hospital, Peshawar from the 12th of September 2019 till 12th March 2020. Sixty children with confirmed cerebral malaria were recruited into the study and based on a randomisation process, were treated with intravenous quinine or intravenous artesunate. Data on age, gender, weight and treatment outcomes were recorded and cross-tabulation made using SPSS 23 with analysis done by stratifying demographic variables.
Results: The study showed that in the treatment of P. falciparum quinine given intravenously was marginally superior to intravenous artesunate in that its effectiveness was higher with 86. 7% compared to 73. 3% of the parasite cleared from the patient’s blood stream. The mortality rate was relatively low in both arms but the artesunate arm had a slightly higher one. Subgroup analysis showed similar trends in favour of quinine across different ages, genders and weights subgroups. However, in all the analysed parameters, the difference was not significant, therefore, it can be said that both treatments can be effective.
Conclusion: In this study both intravenous quinine and artesunate were equally effective for the management of paediatric cerebral malaria however quinine was found to be slightly superior to artesunate. Based on these findings, quinine may still be used in some pediatric cases but artesunate is a much better contender given is faster action and favourable side effect profile. More studies that will incorporate more participants are advised in order to support these findings.
Keywords: Cerebral malaria, Plasmodium falciparum, pediatric, intravenous quinine, intravenous artesunate, efficacy comparison, randomized control trial.