The death rate among children with severe malaria was nearly one-fourth lower when they received a new drug called artesunate than when they got the standard treatment of quinine, a new study shows.
The finding suggests that artesunate should replace quinine as the malaria treatment of choice for severe malaria worldwide, the researchers said.
Malaria can quickly become life-threatening if left untreated, according to the World Health Organisation.
Falciparum malaria most dangerous
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 %) in the artesunate group and 297 deaths (11%) in the quinine group, the study authors reported.
That means the risk of death was 22.5% 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 study authors, Nicholas White of Mahidol University in Bangkok, Thailand, and colleagues from the AQUAMAT study group, also noted that while artesunate is more expensive to buy, quinine is more expensive to administer.
"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," White's team wrote.
WHO recommends artesunate
A previous study found that the malaria death rate among Southeast Asian adults treated with artesunate was 14 %, compared with 23% for those treated with quinine. Following that study, the World Health Organisation changed its guidelines to recommend artesunate for severe malaria in adults.
But this additional study was needed because it was thought the disease course could be different in African children.
"Artesunate should now become the treatment of choice for severe malaria for children and adults worldwide," the authors of the new study concluded.
"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," White said.
"If 4 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," they concluded.
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