Comparison of chloroquine with quinimax in the treatment of cerebral malaria in Ghanaian children

Abstract

Despite earlier reports of R2 and R3 resistance of Plasmodium,1 falciparum to chloroquine. it remained the drug of choice for the treatment of cerebra1 malaria in Ghana. The World Health Organization, however, recommends the use of parenteral quinine salts in such circumstances. In order to guide local treatment policies, an open randomized trial comparing the effect of enteral chloroquine and intravenous followed by oral Quinimax. a quinine preparation approved by the World Health Organization was conducted in 70 children with cerebral malaria. The primary endpoints were mortality, prevalence of residual neurologic sequalae and treatment failure (clinical and parasitological). Thirty-three patients received chloroquine and 37 received Quinimax"'. There was no significant difference in mortality rates (chlorO(IUine. 12.1 %; Quinimax 10.8%; p= 1.00) and neurologic sequelae on day 7 (chloroquine. 12.1%; Quinimax ·, 8.1%; p: O.70) . There was a significantly higher prevalence of early treatment failure in the chloroqU111e group (chloroquine, 12.1 %; Quinimax®. 0%; 1)-"-0.045). Significantly more patients on chloroquine were parasitaemia on day 3 (chloroquine, 21.8%; Qumimax ~. 2.7%; p 0.022) but times to parasite clearance. fever clearance and recovery of full consciousness were similar. We conclude that treatment failure is more likely when chloroquine is used to treat cerebral malaria th'111 when Quinimax® is used. We therefore recommend that quinine salts, or other antimalarial 110 drugs of equal efficacy be used to treat cerebral malaria in Ghanaian children instead of chloroquine.