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Artesunate Substantially Reduces Mortality In African Children With Severe Malaria And Should Replace Quinine As Treatment Of Choice (Aquamat Study)

March 11, 2017

Compared with the standard treatment of quinine, artesunate reduces mortality by around a quarter in children with severe falciparum malaria. Thus artesunate should replace quinine as the treatment of choice worldwide. This new study (the AQUAMAT trial) is published Online First and in an upcoming Lancet, and is being presented at the American Society for Tropical Medicine and Hygiene (ASTMH) meeting in Atlanta on November 6. It is Professor Nicholas White, Mahidol University, Bangkok, Thailand, and colleagues from the AQUAMAT study group. The study was funded by The Wellcome Trust.

Falciparum malaria is a major contributor to child mortality in Africa and one of the main causes of paediatric hospital admission across sub-Saharan Africa. Many deaths occur in or near home, but for children who are admitted to hospital with severe malaria and receive parenteral antimalarial treatment, about one in six will die. Despite being the standard treatment for children with severe falciparum malaria, quinine has its problems, causing a number of side effects.

Following the successful SEAQUAMAT trial (in which artesunate reduced malaria mortality in Southeast Asian adults to 14% from 23% with quinine treatment), WHO in 2006 changed its guidelines to recommend artesunate for severe malaria in adults. However, it was felt that the disease course could be different in African children and thus a separate study-AQUAMAT-was needed to establish the benefits of artesunate in African children.

This randomised trial was undertaken in 11 centres in nine African countries. Children (