Comparison of malaria parasite clearance times during Quinine and Artesunate administration for cerebral malaria in Blantyre, Malawi
Kamuzu University of Health Sciences
Malaria which is caused by Plasmodium species is one of the most important human parasitic diseases. In recent years, preceding 2014, the most severe form of the disease, cerebral malaria, was recommended by World Health Organization (WHO) to be treated with quinine, but due to its increased side effects over the recently discovered drug, artemisinin derivatives, WHO substituted quinine as first line treatment with artemisinin derivatives in combination with a long-acting drug such as lumefantrine, piperaquine, amodiaquine, mefloquine, pyronaridine or sulfadoxine-pyrimethamine. Delay in parasite clearance time in treated patients is the main characteristic of parasite resistance to a particular antimalarial drug. Malaria parasites have already shown resistance to the currently recommended artemisinin derivatives in South East Asia, a development that prompted WHO to recommend periodic monitoring of the drug's effectiveness in endemic countries. Malawian children admitted with cerebral malaria (CM) between 2010 and 2019 in a long-standing pathogenesis study at Blantyre’s main referral hospital, Queen Elizabeth Central Hospital (QECH) were retrospectively sampled at admission and every six hours until two consecutive malaria smears were negative. This was done to monitor parasite clearance times across those years. Yearly average clearance time was compared to 2014, the year when artesunate replaced quinine as first-line therapy for CM in Malawian hospitals. Parasite clearance time was shown to be slower during the quinine era compared to the artesunate, an indication that artesunate is superior to quinine. There was no increase in clearance times from the onset of artesunate as first-line therapy, showing that the current recommended anti-malarial drug is still effective.