PARIS–Replacing quinine by artesunate as the frontline treatment for children with severe malaria could save 100,000 lives a year, according to a landmark trial reported on Saturday.
In 2006, the World Health Organization (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. 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 outcome, published online by The Lancet, found that using artesunate reduced death from severe falciparum malaria among African children by 22.5 percent compared to quinine. The trial was conducted in nine African countries, in which 5,425 badly infected children aged under 15 were given either artesunate or quinine. On the important question of side effects, artesunate was well tolerated, the study found. The risk of coma or convulsion and, after treatment, a low-blood sugar condition known as hypoglycaemia, were all lower in the artesunate group than the quinine group. “Artesunate should now become the treatment of choice for severe malaria for children and adults worldwide,” according to the study, led by Nicholas White, a professor at Mahidol University in Bangkok. “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.” It added: “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.” The active ingredient in artesunate is artemisinin, which was discovered by a Chinese researcher in 1972 in a project to follow up advice found in ancient Chinese medicine. The drug’s effectiveness, though, has been overshadowed by concerns about cost, availability and counterfeiting. The AQUAMAT trial among the children in Africa was inspired by the results of a trial among malaria-infected adults in Southeast Asia, which led to the new WHO guidelines in 2006. Quinine was introduced to European medicine in the 1630s and persisted as the front-line treatment for severe malaria until the 1950s, when chloroquine became available. Chloroquines were eventually ousted by parasite resistance, which began in Southeast Asia and spread to Africa at the end of the 1970s, prompting the return of quinine. According to the WHO’s website, nearly one million people died from malaria in 2008, most of them African children.