To compare the relapse rate of artesunate with tetracycline and quinine with tetracycline in uncomplicated falciparum malaria

Abstract

Objective: To determine the relapse rate of falciparum malaria treated with artesunate plus tetracycline (AT) versus quinine plus tetracycline (QT) in uncomplicated patients of malaria. Methodology: A cross sectional comparative study was carried out at Combined Military Hospital, Quetta from 01 May to 30 November 2006. Ninety patients of age-sex matched group with uncomplicated falciparum malaria having parasitemia >1%, age between 14-65yrs, either sex and with no previous malaria treatment related to the present attack were recruited from emergency department, medical wards, included in the study. One group was given quinine along with tetracycline (QT) and the other group was given artemesinin and tetracycline (AT). The patient was discharged from the hospital when three negative blood smears were obtained. Thereafter, blood smears were taken at days 7, 14, 21 & 28 after the start of the treatment, as outdoor patients. Parasitological response was regarded as radical cure with parasite clearance by day 7 without recrudescence up to day 28. Fever and parasite clearance times were noted as the time from the initiation of treatment to the first of three consecutive normal axillary temperature readings (<370 C) or negative blood peripheral film slides, respectively. Results: Out of 90 patients of falciparum malaria, treatment was completed in 85 patients. The cure rates using treatment with AT was effective in 35 of 45 (77.7%) while QT was effective in 34 of 45 (75.5%) of the patients without any statistically significant difference (p = 0.68). Poor compliance with the treatment schedule was observed in 2 of 45 (4.4%) in the AT group and 4 of 45 (8.8%) QT group of patients. Cure rates of 95.5% and 91.1% would have been obtained in the AT and QT groups if only compliant patients (n = 69) were considered. Parasitemia at day two cleared faster in the AT group than the QT group (91.1% versus 44.4%, respectively; p-value <0.001). Conclusion: Combination of artesunate plus tetracycline is effective in the treatment of uncomplicated falciparum malaria and may provide a useful alternative to other treatment regimens.