Artesunate compared with quinine for the treatment of severe malaria in adult patients managed in an intensive care unit: A retrospective observational study
Background. There are limited South African data on the outcomes of patients with severe malaria treated with quinine compared with those treated with artesunate in the intensive care unit (ICU).
Objectives. To compare the outcomes of adult patients treated with artesunate against those treated with quinine in the ICU. Primary outcome variables are length of stay (LOS) in the ICU and mortality. Secondary outcomes include the incidence of hypoglycaemic episodes and neurological outcomes.
Methods. This was a retrospective cohort study of patients with severe malaria treated at a multidisciplinary ICU with artesunate or quinine from 1 January 2008 to 31 December 2012.
Results. Of the 92 patients included in the study, 63 (69.2%) were male. The mean age in the quinine and artesunate groups was 36.2 years and 40.5 years, respectively (p=0.071). Most (98.6%) of the patients with a positive travel history had visited a malaria-endemic region. Of the 53 patients tested for HIV infection, 71.7% tested positive (p=0.520). The average CD4+ cell count of HIV-positive patients treated with quinine was 200 cells/μL compared with 217.17 cells/μL for those treated with artesunate (p=0.875). The mean APACHE II score at admission was 20.85 and 19.62 in the quinine group and artesunate group, respectively (p=0.380). The median LOS was 5 days (range 1 - 27). Mortality was 15.4% in the quinine group and 7.7% in the artesunate group (p=0.246).
Conclusion. A statistically insignificant mortality difference was observed in outcomes of the two treatment groups in this retrospective, single-centre cohort study.
R M Mathiba, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
L R Mathivha, Department of Intensive Care, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Division of Critical Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
G D Nethathe, Division of Critical Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Date published: 2019-08-15
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