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Parenteral artesunate reduced inhospital mortality more than quinine in severe falciparum malaria

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 Q What is the relative effectiveness of parenteral artesunate and parenteral quinine for patients with severe falciparum malaria?

Clinical impact ratings Infectious disease ★★★★★★☆ Tropical & travel medicine ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial (South East Asian Quinine Artesunate Malaria Trial [SEAQUAMAT]).

Embedded ImageAllocation:


Embedded ImageBlinding:

blinded (microscopists assessing parasite counts and stages and data analysts).*

Embedded ImageFollow up period:

to discharge.

Embedded ImageSetting:

10 centres in Bangladesh, Myanmar (Burma), India, and Indonesia.

Embedded ImagePatients:

1461 patients >2 years of age (mean age 28 y, 74% men) who had a diagnosis of severe malaria and a positive blood antigen stick test for Plasmodium falciparum histidine rich protein 2. Exclusion criteria: history of full treatment with quinine or an artemisinin derivative for >24 hours before admission or known allergy to artemisinin derivatives or quinine.

Embedded ImageIntervention:

730 patients were allocated …

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  • * See glossary.

  • For correspondence: Professor N J White, Mahidol University, Bangkok, Thailand. nickw{at}

  • Source of funding: Wellcome Trust.

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