A Trial of Artemether or Quinine in Children with Cerebral Malaria

About half a million African children die each year as a result of cerebral malaria. The recommended therapy is parenteral quinine, but the case fatality rate is 10 to 30 percent despite treatment. 1 , 2 Quinine has several other limitations. Because of its potential toxicity it is ideally administered by carefully controlled intravenous infusion — a procedure that is often impractical in rural health clinics, especially in young children. Under these circumstances, the World Health Organization recommends administration by the intramuscular route, 3 which is equally effective in terms of parasite clearance but tends to produce irritation and, infrequently, abscess formation at . . .