Rectal dihydroartemisinin versus intravenous quinine in the treatment of severe malaria: a randomised clinical trial.

OBJECTIVE To compare the clinical efficacy and safety of rectal dihydroartemisinin (DATM--Cotecxin) and intravenous quinine in the treatment of severe malaria in children and adults. SETTING Moi Teaching and Referral Hospital, Eldoret, Kenya between July and November 1998. PATIENTS A total of sixty seven patients aged two to sixty years with severe malaria were studied. DESIGN This was an open randomised comparative clinical trial. OUTCOME MEASURES These were parasite clearance time, fever clearance time, efficacy and the side effect profile of the two drugs. RESULTS The two groups were comparable on admission on the clinical and laboratory parameters. The parasite clearance time was shorter in the rectal DATM group than quinine group. There was no statistical difference on the fever clearance time and cure rates in the two groups. The adverse reaction profile was better with rectal DATM than with quinine, tinnitus observed more in the quinine group. CONCLUSION Rectal DATM is faster in parasite clearance than quinine and is a safe and convenient alternative to quinine in the treatment of severe malaria.