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Letters to the Editor Indian Pediatrics 2004; 41:520-521 |
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Artemether in Children with Severe Malaria |
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I read with interest the recent article by Huda, et al.(1). Based on an open randomized trial, they found artemether to be a good alternative to quinine for severe Plasmodium falciparum malaria. However, I would like to make certain observations. In previous studies done on male Rhesus monkeys, artemether and other related compounds were found to cause significant brain injury and Petras, et al.(2) found neuropathological lesions in medu-llary precerebellar nuclei after treatment. A longer duration of follow-up and a larger sample size in this study would have been useful in reassuring that neurological sequelae really did not occur in children after artemether therapy. Secondly, there is a concern about the bioavailability of intramuscularly adminis-tered artemether in children in cerebral malaria. In a previous study(3) done on Kenyan children, 19% were found to have low serum drug concentrations with a signi-ficantly longer 50% parasite clearing time. Finally, there are concerns about increasing prevalence of drug resistance (including artesunate) in India(4). Though the overall cost of artemether is comparable to that of quinine, one should use artemether judiciously in selected cases to prevent an escalation of drug resistance to artemether. The data presented in this study still does not support the use of artemether as the first choice drug for severe malaria, and quinine is still the drug of first choice in my opinion. Sudhir Kumar, |
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