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Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

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dc.contributor.author Achan, J.
dc.contributor.author Tibenderana, J. K.
dc.contributor.author Kyabayinze, D.
dc.contributor.author Mangen, F. W.
dc.contributor.author Kamya, M. R.
dc.contributor.author Dorsey, G.
dc.contributor.author D'Alessandro, U.
dc.contributor.author Rosenthal, P. J.
dc.contributor.author Talisuna, A. O.
dc.date.accessioned 2009-08-24T08:49:30Z
dc.date.available 2009-08-24T08:49:30Z
dc.date.issued 2009
dc.identifier.issn 0959-8146
dc.identifier.issn FTA
dc.identifier.doi http://dx.doi.org/10.1136/bmj.b2763
dc.identifier.other ITG-P7A
dc.identifier.other ITG-PLB
dc.identifier.other PARAS
dc.identifier.other U-MALAR
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other UPD16
dc.identifier.other ABSTRACT
dc.identifier.uri http://hdl.handle.net/10390/2744
dc.description.abstract OBJECTIVE: To compare the effectiveness of oral quinine with that of artemether-lumefantrine in treating uncomplicated malaria in children. DESIGN: Randomised, open label effectiveness study. SETTING: Outpatient clinic of Uganda's national referral hospital in Kampala. PARTICIPANTS: 175 children aged 6 to 59 months with uncomplicated malaria. INTERVENTIONS: Participants were randomised to receive oral quinine or artemether-lumefantrine administered by care givers at home. MAIN OUTCOME MEASURES: Primary outcomes were parasitological cure rates after 28 days of follow-up unadjusted and adjusted by genotyping to distinguish recrudescence from new infections. Secondary outcomes were adherence to study drug, presence of gametocytes, recovery of haemoglobin concentration from baseline at day 28, and safety profiles. RESULTS: Using survival analysis the cure rate unadjusted by genotyping was 96% for the artemether-lumefantrine group compared with 64% for the quinine group (hazard ratio 10.7, 95% confidence interval 3.3 to 35.5, P=0.001). In the quinine group 69% (18/26) of parasitological failures were due to recrudescence compared with none in the artemether-lumefantrine group. The mean adherence to artemether-lumefantrine was 94.5% compared with 85.4% to quinine (P=0.0008). Having adherence levels of 80% or more was associated with a decreased risk of treatment failure (0.44, 0.19 to 1.02, P=0.06). Adverse events did not differ between the two groups. CONCLUSIONS: The effectiveness of a seven day course of quinine for the treatment of uncomplicated malaria in Ugandan children was significantly lower than that of artemether-lumefantrine. These findings question the advisability of the recommendation for quinine therapy for uncomplicated malaria in Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT00540202. en
dc.language English en
dc.subject Protozoal diseases en
dc.subject Malaria en
dc.subject Plasmodium falciparum en
dc.subject Drug policy en
dc.subject First-line drugs en
dc.subject Antimalarials en
dc.subject Quinine en
dc.subject Artemisinin combination therapies (ACT) en
dc.subject Artemether-lumefantrine en
dc.subject Home-based care en
dc.subject Treatment outcomes en
dc.subject Effectiveness en
dc.subject Compliance en
dc.subject Adverse effects en
dc.subject Clinical trials en
dc.subject Uganda en
dc.subject Africa, East en
dc.title Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial en
dc.type Article en
dc.citation.issue 7715 en
dc.citation.jtitle BMJ en
dc.citation.volume 339 en
dc.citation.pages 283-289 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/19622553
dc.citation.jabbreviation BMJ en


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