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Artesunate, Not Quinine Best Treatment for Malaria


Quinine is nearly synonymous with malaria, and the drug has been used worldwide to treat this disease for more than 300 years. Now scientists say that another drug—artesunate—is the best treatment for severe malaria in both children and adults.

Artesunate is superior to quinine in preventing death

An international team of researchers headed by Professor Nick White of the Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme in Bangkok, Thailand, conducted the largest ever clinical trial of patients with severe malaria. The five-year trial compared quinine, the centuries-old treatment for malaria, against artesunate, which is used in Asia.

A total of 5,425 children with severe malaria from nine African countries and 11 hospitals were enrolled in the trial, which was known as the African Quinine v. Artesunate Malaria Trial (AQUAMAT). AQUAMAT was funded entirely by Wellcome Trust and received no support or funding from the pharmaceutical industry.

Although malaria affects both children and adults, children are the hardest hit. According to the World Health Organization, in 2008 there were 247 million cases of malaria around the world and nearly one million deaths, mostly among children living in Africa. Every 45 seconds a child dies of malaria in Africa, where the disease is responsible for 20 percent of all childhood deaths.

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Quinine is derived from the bark of a South American tree, and while it has been reliable, it is difficult to inject and has many undesirable side effects, some of which can be dangerous. Artesunate is extracted from a Chinese herb called ginghao (Artemisia annua). About 40 years ago, Chinese researchers reported that extracts of the herb had anti-malarial properties, but it has taken many years for the treatment to gain acceptance.

AQUAMAT compared quinine against artesunate given intravenously or by intramuscular injection. Artesunate reduced the number of deaths from severe malaria by 22.5 percent compared with quinine, with results being very similar in all the study locations.

The study’s researchers reported that artesunate was less likely to cause children to slip into a deeper coma, to experience seizures, and to have dangerously low blood sugar. Artesunate was also easy to administer, safe, and well tolerated by the children.

This is not the first study to compare quinine with artesunate. In 2005, a large trial involved adults in Asia who had severe malaria and who were treated with artesunate injections. In that trial, the death rate in artesunate-treated patients was better than that in adults treated with quinine. Scientists, however, were not certain those results would also apply to children in Africa, where quinine is still the treatment of choice for children.

According to Professor White, with the development of artesunate, “we now have a safer and much more effective treatment. We recommend that artesunate should now replace quinine for the treatment of severe malaria in both children and adults everywhere in the world.”

Wellcome Trust
World Health Organization