Artesunate versus quinine in the treatment of severe falciparum malaria malaria in African children (AQUAMAT): an open-label, randomized trial

ECDC comment

This paper describes the results of an open-label randomized trial, comparing the use of artesunate and quinine for the treatment of severe Plasmodium falciparum malaria in children in 11 African countries.

Arjen M Dondorp, Caterina I Fanello, Ilse C E Hendriksen, et al for the AQUAMAT group*, Lancet, 2010;376(9753):1647-57

This paper describes the results of an open-label randomized trial, comparing the use of artesunate and quinine for the treatment of severe Plasmodium falciparum malaria in children in 11 African countries. In the artesunate treatment group, 230 patients (8·5%) died in the hospital, compared with 297 (10·9%) assigned to quinine treatment group, giving an odds ratio stratified for study site of 0·75, with a 95% confidence interval of 0·63–0·90. Treatment with artesunate reduced the mortalityof severe malaria by 22·5%, in comparison with quinine. These results support the use of artesunate treatment as a first choice for the treatment of children with severe Plasmodium falciparum malaria.

ECDC comment: This large study is encouraging for the use of parenteral artesunate for the treatment of severe Plasmodium falciparum malaria cases in European travel medicine.Public Health Significance: The evidence provided by this publication on the efficacy and safety of the use of parenteral artesunate for the treatment of severe Plasmodium falciparum malaria is of great importance regarding the improvement of malaria treatment and mortality.

This paper was selected by Dr. Helena H. Askling (helena.hervius-askling@karolinska.se) from Stockholm, Sweden on behalf of EuroTravNet. EuroTravNet, the European Travel Medicine Network, is an ECDC collaborative network. Read more