Severe and complicated malaria treated with artemisinin, artesunate or artemether in Viet Nam

One hundred and seventy five Vietnamese adults with severe and complicated malaria admitted to a rural district hospital were entered into an open randomized comparative study to compare 4 treatment regimens based on artemisinin and its derivatives. The median time of defervescence was 48 h (95% confident interval [CI] 38–58 h) in those given intramuscular (i.m.) artemether, 42 h (95% CI 36–48 h) in those given artemisinin suppositories, 36 h (95% CI 30–42 h) in those receiving artesunate (i.m.) and 30 h (95% CI 18–42 h) in those receiving intravenous artesunate ( P = 0 · 13). The respective median parasite clearance times were 30 h (95% CI 26–34 h), 30 h (95% CI 24–36 h), 24 h (95% CI 15–33 h), and 24 h (95% CI 15–33 h) ( P = 0 · 30); the median times for recovery of consciousness were 47 h (95% CI 31–63 h), 24 h (95% CI 18–30 h), 30 h (95% CI 18–42 h), and 24 h (95% CI 4–44 h) ( P = 0 · 18); and the mortality rates were 11 · 1%, 17 · 6%, 10 · 2% and 16 · 6%, respectively ( P = 0 · 64). There was no significant difference in efficacy between the 4 treatments.