Malaria drug artesunate found more effective than quinine at preventing severe falciparum malaria deaths in children, study says

Researchers found that the death rate among children diagnosed with severe falciparum malaria was almost one-fourth lower when they received the drug artesunate rather than the standard treatment of quinine, according to research which was presented at the American Society for Tropical Medicine and Hygiene (ASTMH) over the weekend and published Monday in the Lancet, HealthDay News/U.S. News and World Report writes. The results have the potential to change the WHO's malaria treatment recommendations for children, according to the article (11/6).

In 2006, the WHO "recommended that artesunate, derived from a Chinese plant called sweet wormwood, replace the four-century-old remedy of quinine for treating severe malaria in adults," Agence France-Presse/Sydney Morning Herald writes. "But, acting cautiously, it said it could not make a similar recommendation for children until a further trial on this age group had been carried out," the news service notes (11/7). "The finding suggests that artesunate should replace quinine as the malaria treatment of choice for" children with severe malaria, the researchers said, HealthDay News/U.S. News and World Report writes.

"The new study included 5,425 children with severe falciparum malaria - the most dangerous of four types of malaria affecting humans - in nine African countries. Of the children, 2,713 were treated with artesunate and 2,713 with quinine. There were 230 deaths (8.5 percent) in the artesunate group and 297 deaths (11 percent) in the quinine group, the study authors reported," according to the news service. "That means the risk of death was 22.5 percent lower for children who received artesunate. The investigators also found that side effects such as coma and convulsions were less frequent among those given artesunate," the news service reports (11/6). Nick White of the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme in Bangkok, Thailand, led the international group of researchers on the five-year trial, which is "known as the 'African quinine versus artesunate malaria trial' (AQUAMAT)," according to a press release from the Wellcome Trust, which funded the study (11/8).

AFP/Sydney Morning Herald notes that the AQUAMAT research "was inspired by the results of a trial among malaria-infected adults in Southeast Asia, which led to the new WHO guidelines in 2006" (11/7). 

White and colleagues also "noted that while artesunate is more expensive to buy, quinine is more expensive to administer," HealthDay News/U.S. News and World Report adds. "A major factor restricting the deployment of artesunate has been unavailability of a product satisfying international good manufacturing standards. The most widely used product, assessed in this study, does not yet have this certification, which has prevented deployment in some countries. This barrier must be overcome speedily so that parenteral artesunate can be deployed in malaria-endemic areas to save lives," they wrote (11/6).

In the study, they also point out: "Malaria causes an estimated 800,000 deaths every year in African children. Severe malaria is often the most common admission diagnosis in febrile children, so a change in treatment policy from quinine to artesunate has the potential to save thousands of children's lives every year," HealthDay News/U.S. News and World Report writes. "If four million African children with severe malaria every year were to receive prompt treatment with parenteral artesunate instead of quinine, and the benefits were similar to those recorded in this trial, then approximately 100,000 lives might be saved per year," according to the researchers (11/6).