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Letters to the Editor Indian Pediatrics 2004; 41:521-522 |
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Reply |
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The study of Petras et al.(1) quoted by Dr. Kumar was done on male rhesus monkey using high doses (8 mg/kg/day to 24 mg/kg/day) of arteether for 7 to 14 days. Neuropathological lesions were demons-trated only in the 14-day treated monkeys. The recommended doses and duration of therapy in humans is much less. Secondly, it may not be entirely appropriate to extrapolate results in experimental animals to humans. Moreover, a study in mouse model has demonstrated that neuro-pathological brain-stem damage due to intramuscular artemether is dose dependent and may be reversible(2). We do not perceive how longer duration of follow up in our study could have helped to detect neurological sequelae in the patients when they were clinically normal at discharge. A larger sample size would have definitely helped. The study quoted on bioavailability of intramuscular artemether was done on just 26 children(3). This observation needs to be validated by larger studies. We share Dr. Kumar’s concern for emerging drug resistance and certainly do not recommend replacing quinine with artemether. We have only suggested that artemether may be a useful alternative to quinine in areas with poor medical facility for reasons already cited in the article. Kamran Afzal, |
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