Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine
<strong>Background</strong> Parenteral artesunate is the treatment of choice for severe malaria. Recently, haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries. <strong>Methods&l...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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BioMed Central
2017
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| _version_ | 1826259965710434304 |
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| author | Fanello, C Onyamboko, M Lee, S Woodrow, C Setaphan, S Chotivanich, K Buffet, P Jauréguiberry, S Rockett, K Stepniewska, K Day, N White, N Dondorp, A |
| author_facet | Fanello, C Onyamboko, M Lee, S Woodrow, C Setaphan, S Chotivanich, K Buffet, P Jauréguiberry, S Rockett, K Stepniewska, K Day, N White, N Dondorp, A |
| author_sort | Fanello, C |
| collection | OXFORD |
| description | <strong>Background</strong> Parenteral artesunate is the treatment of choice for severe malaria. Recently, haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries. <strong>Methods</strong> To assess these potential safety concerns in African children, in whom most deaths from malaria occur, an open-labelled, randomized controlled trial was conducted in Kinshasa, Democratic Republic of Congo. 217 children aged between 6 months and 14 years with acute uncomplicated falciparum malaria and parasite densities over 100,000/μL were randomly allocated to intravenous artesunate or quinine, hospitalized for 3 days and then followed for 42 days. <strong>Results</strong> The immediate reduction in haemoglobin was less with artesunate than with quinine: median (IQR) fall at 72 h 1.4 g/dL (0.90–1.95) vs. 1.7 g/dL (1.10–2.40) (p = 0.009). This was explained by greater pitting then recirculation of once infected erythrocytes. Only 5% of patients (in both groups) had a ≥ 10% reduction in haemoglobin after day 7 (p = 0.1). One artesunate treated patient with suspected concomitant sepsis had a protracted clinical course and required a blood transfusion on day 14. <strong>Conclusions</strong> Clinically significant delayed haemolysis following parenteral artesunate is uncommon in African children hospitalised with acute falciparum malaria and high parasitaemias. |
| first_indexed | 2024-03-06T18:58:10Z |
| format | Journal article |
| id | oxford-uuid:1293d668-89c7-4710-b64b-abb05235c100 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:58:10Z |
| publishDate | 2017 |
| publisher | BioMed Central |
| record_format | dspace |
| spelling | oxford-uuid:1293d668-89c7-4710-b64b-abb05235c1002022-03-26T10:08:45ZPost-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinineJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:1293d668-89c7-4710-b64b-abb05235c100EnglishSymplectic Elements at OxfordBioMed Central2017Fanello, COnyamboko, MLee, SWoodrow, CSetaphan, SChotivanich, KBuffet, PJauréguiberry, SRockett, KStepniewska, KDay, NWhite, NDondorp, A<strong>Background</strong> Parenteral artesunate is the treatment of choice for severe malaria. Recently, haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries. <strong>Methods</strong> To assess these potential safety concerns in African children, in whom most deaths from malaria occur, an open-labelled, randomized controlled trial was conducted in Kinshasa, Democratic Republic of Congo. 217 children aged between 6 months and 14 years with acute uncomplicated falciparum malaria and parasite densities over 100,000/μL were randomly allocated to intravenous artesunate or quinine, hospitalized for 3 days and then followed for 42 days. <strong>Results</strong> The immediate reduction in haemoglobin was less with artesunate than with quinine: median (IQR) fall at 72 h 1.4 g/dL (0.90–1.95) vs. 1.7 g/dL (1.10–2.40) (p = 0.009). This was explained by greater pitting then recirculation of once infected erythrocytes. Only 5% of patients (in both groups) had a ≥ 10% reduction in haemoglobin after day 7 (p = 0.1). One artesunate treated patient with suspected concomitant sepsis had a protracted clinical course and required a blood transfusion on day 14. <strong>Conclusions</strong> Clinically significant delayed haemolysis following parenteral artesunate is uncommon in African children hospitalised with acute falciparum malaria and high parasitaemias. |
| spellingShingle | Fanello, C Onyamboko, M Lee, S Woodrow, C Setaphan, S Chotivanich, K Buffet, P Jauréguiberry, S Rockett, K Stepniewska, K Day, N White, N Dondorp, A Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title | Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title_full | Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title_fullStr | Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title_full_unstemmed | Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title_short | Post-treatment haemolysis in African children with hyperparasitaemic falciparum malaria; a randomized comparison of artesunate and quinine |
| title_sort | post treatment haemolysis in african children with hyperparasitaemic falciparum malaria a randomized comparison of artesunate and quinine |
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