Comparison of chloroquine with artesunate in the treatment of cerebral malaria in Ghanaian children.

Despite previously reported chloroquine-resistant forms of Plasmodium falciparum in Ghana chloroquine remains the drug of choice in severe malaria. Artemisinin derivatives have been shown to be effective against chloroquine-resistant strains in other endemic areas. This open randomized study was conducted to compare the efficacy of chloroquine and artesunate in the treatment of childhood cerebral malaria. Out of 82 subjects that fulfilled the inclusion criteria 36 were randomized to receive chloroquine and 46 to receive artemisinin. Blantyre coma scores temperature and parasitemia were monitored. Mortality and neurological deficits were documented. There was no difference in mortality rates (chloroquine 16.7%; artesunate 21.7%; p = 0.6) neurological deficit at day 14 (chloroquine 0%; artesunate 4.3%; p = 0.3) resolution of fever (p = 0.55) and coma recovery time (p = 0.8) between the two groups. The results suggest that syrup chloroquine and intramuscular/oral artesunate currently give comparable clinical responses in the treatment of cerebral malaria in Ghana. Possible reasons for this are discussed and suggestions are made for future antimalarial drug policy. (authors)