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Beyond quinine

Artesunate saves more lives in severe adult cases

LONDON: Treating adults with severe cases of malaria with the drug artesunate — rather than quinine — could save tens of thousands of lives in the developing world, new research suggests.

A study outlined this week in The Lancet medical journal shows for the first time that artesunate is better at saving lives than the standard medication, quinine, and reduces the chance of death from malaria by 35 per cent.

Scientists have known for some years that the newer drug — derived from a traditional herb that has been used in Chinese medicine for thousands of years to treat fever — works more quickly, is easier to use and has fewer side effects. But it has been unclear whether it was any better at preventing death.

In the study, a team led by Dr. Nick White at Mahidol University in Bangkok, compared the drugs in 1,461 adults with severe malaria being treated in hospitals in Bangladesh, Indonesia, India and Myanmar.

Half the patients were given intravenous artesunate, while the other half were treated with quinine. The researchers found that while 164, or 22 per cent, of the patients on quinine died from their malaria, only 107, or 15 percent, of the patients getting artesunate died.

The World Health Organisation said the findings will prompt a change in its guidelines on the treatment of adults with severe malaria in areas such as Southeast Asia and South America, locations where the parasite has shown resistance to quinine. "Before the paper came out, all we could say was that artesunate was as good as quinine, so the recommendation was that we had no evidence to recommend one over the other," said Dr. Peter Olumese, a malaria drug policy expert at the U.N. health agency. "Now, with this paper, at least for that setting, we can clearly say yes, artesunate is the drug of choice."

In such locations, switching to artesunate could save the lives of tens of thousands of the estimated million people who die from malaria every year, Dr. Olumese said.

However, most of the world's malaria deaths occur in Africa, where it is mostly children who are affected. Whether artesunate would be better than quinine in that situation remains unclear, Dr. Olumese said.

The disease progresses differently in children and the drug may work differently in them, so until studies prove artesunate is better than quinine in children, the old drug will remain the treatment of choice, he said. — AP

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