In Thailand
Plasmodium falciparum malaria is highly resistant to available
antimalarials. Investigations on the efficacy of existing
antimalarials and of alternative drugs are urgently needed.
Artesunate has been shown to be effective against
falciparum malaria, but is associated with a high recrudescence rate. We have carried out a comparative clinical trial of the standard regimen of
quinine +
tetracycline versus oral
artesunate at a 700-mg total dose given over 5 days to patients with acute uncomplicated
falciparum malaria. The 64 male patients who took part in the study were randomized to receive either
quinine-
tetracycline (33 patients) or oral
artesunate (31 patients). All the patients were admitted to the Bangkok Hospital for Tropical Diseases for 28 days. Oral
artesunate had faster parasite and
fever clearance times than the combination
quinine-
tetracycline, but the cure rate was not significantly different for the two regimens. However, the occurrence of adverse effects, such as
tinnitus, was significantly higher in the
quinine-
tetracycline group. Surprisingly
nausea and
dizziness were rather common with
artesunate. The possibility of neurological adverse effects for
artesunate should also be borne in mind. Oral
artesunate (700 mg given over 5 days) is effective and better tolerated than the combination
quinine-
tetracycline. The cure rate we obtained is higher than that reported in previous studies with 600 mg of oral
artesunate given over 5 days. Oral
artesunate can be considered as an alternative
drug for multiple-
drug-resistant
falciparum malaria; however, adverse effects, particularly neurotoxicity, should be closely monitored before its widespread use can be recommended.(ABSTRACT TRUNCATED AT 250 WORDS)