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Objective: To compare the efficacy and safety of rectal artemether with intrav enous quinine in the reatment of cerebral malaria in children.Design: Randomised, single blind, clinical trial.Setting: Acute care unit at ulago Hospital, Uganda’s national referral and teaching hospital in Kampala.Participants: 103 children aged 6 onths o 5 years with cerebral malaria.Intervention: Patients were randomised to either intravenous quinine or rectal rtemether for seven days.Main outcome measures: Time to clearance of parasites and fever; time to regaining onsciousness, starting oral intake, and sitting unaided; and adverse effects.Results: The difference in arasitological nd clinical outcomes between rectal artemether and intravenous quinine did not reach significance (parasite clearance time 54.2 (SD 33.6) hours v 55.0 (SD 24.3) hours, P = 0.90; fever clearance time 33.2 (SD 21.9) hours v 4.1SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 (SD 24.1) hours v 22.67 (SD 18.5) hours, P = 0.10; ime to starting oral intake 37.9 (SD 27.0) hours v 30.3 (SD 21.1) hours, P = 0.14)－.Mortality was higher in the quinine roup than in the artemether group (10/52 v 6/51; relative risk 1.29, 95％confidence interval 0.84 to 2.01).No serious mmediate adverse effects occurred.Conclusion: Rectal artemether is effective and well tolerated and could be used s reatment for cerebral malaria.
Objective: To compare the efficacy and safety of rectal artemether with intrav enous quinine in the reatment of cerebral malaria in children. Design: Randomized, single blind, clinical trial. Set: Acute care unit at ulago Hospital, Uganda’s national referral and teaching hospital in Kampala.Participants: 103 children aged 6 onths o 5 years with cerebral malaria.Intervention: Patients were randomized to either intravenous quinine or rectal rtemether for seven days. Main outcome measures: Time to clearance of parasites and fever; time to regaining onsciousness, starting oral intake, and sitting unaided; and adverse effects. Results: The difference in arasitological nd clinical outcomes between rectal artemether and intravenous quinine did not reach significance (para 24, 0.90; fever clearance time 33.2 (SD 21.9) hours v 4.1SD 18.9 hours, P = 0.08; time to regaining consciousness 30.1 (SD 24.1) hours v 22.67 P = 0.10; ime to starting oral intake 37.9 (SD 27.0) hours v 30.3 (SD 21.1) hours, P = 0.14) -. Mortality was higher in the quinine roup than in the artemether group (10/52 v 6/51; relative risk 1.29, 95% confidence interval 0.84 to 2.01) .No serious mrait over effects occurred. Conlusion: Rectal artemether is effective and well tolerated and could be used reatment for cerebral malaria.