Clinical trial of beta-arteether versus quinine for the treatment of cerebral malaria in children in Yaounde, Cameroon.

One hundred and two children aged 0-10 years with cerebral malaria (Blantyre coma score of 2 or less) were randomly treated either with intramuscular arteether (3.2 mg/kg on Day 0, followed by 1.6 mg/kg on Days 1 to 4) or intravenous (i.v.) quinine dihydrochloride (20 mg of the salt/kg, followed by 10 mg of the salt/kg every 8 hr up to Day 6). Treatment with oral quinine sulfate (10 mg/kg every 8 hr) was substituted for i.v. quinine when the patient was able to take oral medicine. All patients were followed up in the hospital for 7 days; thereafter, they were treated as outpatients on Days 14, 21, and 28. Mortality rate, the main efficacy parameter, was 11.8% lower in the arteether treatment group than in the quinine group (15.7% versus 27.4%); however, the difference was not significant (P = 0.25). Means for fever clearance time, coma resolution time, and parasite clearance time were similar in the 2 treatment groups (42.2 +/- 34.9 hr; 34.8 +/- 18.8 hr, and 46.3 +/- 28.5 hr, respectively for arteether, versus 45.0 +/- 26.7 hr; 30.3 +/- 18.9 hr, and 40.7 +/- 18.9 hr, respectively, for quinine). At 28 days, the cure rates were 73.2% and 64.9% for the arteether and quinine treatment groups, respectively. Arteether is safe and therapeutically at least as effective as quinine for the treatment of cerebral malaria in children in Cameroon. Because of its ease of administration, arteether appears to be suited for use in the rural zones where monitoring facilities do not exist.

Approche etiologique des anemies severes de l'enfant a partir d'examens paracliniques simples

Les auteurs de ce texte ont eu pour objectif d'etudier l'apport de cinq examens complementaires simples; peu couteux; dans l'approche etiologique des anemies severes de l'enfant. 78 enfants ages de 1 mois a 5 ans ayant un taux d'hemoglobine inferieur a 8g/100ml ont eu une numeration sanguine; une numeration des reticulocytes; une goutte epaisse; une electrophorese de l'hemoglobine. 48 d'entre-eux ont eu un examen parasitologique des selles. Le taux moyen d'hemoglobine etait de 4;5g/100ml. 52 malades (66;7 pour cent) avaient une microcytose et/ou une hypochromie; faisant evoquer une carence martiale isolee ou associee a d'autres causes. 9 (11;5 pour cent) avaient une macrocytose; faisant suspecterune carence en acide folique. 49 (62;8 pour cent) avaient une goutte epaisse positive a Plasmodium falciparum. 51 malades (65;4 pour cent) presentaient un ou plusieurs signes cliniques en faveur d'une hemolyse. 3 enfants seulement sur 48 ayant produit des selles (6;2 pour cent) portaient des parasites intestinaux anemiants (2 cas d'ankylostomes; 1 cas d'entamoeba histolytica). 1 enfant etait drepanocytaire homozygote. Au total; ces anemies severes avaient des etiologies multifactorielles dominees par la carence martiale et l'hemolyse palustre