Document Detail


Intravenous artesunate versus intravenous quinine in the treatment of severe falciparum malaria: a retrospective evaluation from a UK centre.
MedLine Citation:
PMID:  23265377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Despite evidence from developing world trials that intravenous (IV) artesunate (AS) is superior to IV quinine (Q) in severe falciparum malaria (FM), IV AS remains unlicensed in the UK with national guidelines listing it as an acceptable alternative to IV Q as the drug of choice. We retrospectively evaluate the safety and effectiveness of IV AS in returning travellers with severe FM.
METHODS: We identified adults admitted to the Infectious Diseases unit with severe FM and treated with IV Q (1991-2009) or IV AS (2009-2011). Outcomes included adverse events, mortality, length of stay, admission to intensive care and, where data were available, parasite/fever clearance time and hypoglycaemic events.
RESULTS: Of 167 patients, 24 received IV AS and 143 IV Q. There was one potential AS-associated adverse event, a case of late onset haemolysis. Median length of stay (LOS) was significantly shorter for AS (3·5 versus 5 days, P = 0·017), even after adjusting for African ethnicity (for LOS ≥3 days, mhor = 0·33, P = 0·027; crude OR = 0·29, P = 0·013). In the AS group, there were no fatalities (versus five in Q group, NS) and fewer intensive care unit (ICU) admissions (NS). Median parasite clearance was significantly faster in AS (65 versus 85 hours in Q, P = 0·0045) with no hypoglycaemic episodes (versus five in Q).
DISCUSSION: We found IV AS to be safe and effective, with shorter LOS, faster parasite and fever clearance, no fatalities or hypoglycaemic events, and fewer ICU admissions versus IV Q. This corroborates both developing world trials and smaller European case series (although these lacked comparison groups). As well as obvious benefits for patients, there are potential resource savings. A case of late-onset haemolysis may represent an adverse event, particularly as it has been documented elsewhere, warranting further investigation. Nonetheless, our experience suggests IV AS should be first-line for treating severe FM in the UK.
Authors:
Marcus Eder; Hugo Farne; Tamsin Cargill; Aula Abbara; Robert N Davidson
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Pathogens and global health     Volume:  106     ISSN:  2047-7732     ISO Abbreviation:  Pathog Glob Health     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-12-25     Completed Date:  2013-05-29     Revised Date:  2014-01-24    
Medline Journal Info:
Nlm Unique ID:  101583421     Medline TA:  Pathog Glob Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  181-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Administration, Intravenous
Adolescent
Adult
Aged
Aged, 80 and over
Artemisinins / administration & dosage*,  adverse effects
Drug-Related Side Effects and Adverse Reactions / epidemiology
Female
Great Britain
Humans
Length of Stay
Malaria, Falciparum / drug therapy*,  mortality,  pathology
Male
Middle Aged
Quinine / administration & dosage*,  adverse effects
Retrospective Studies
Survival Analysis
Travel
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Artemisinins; 83507-69-1/artesunate; A7V27PHC7A/Quinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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