Malaria at Chris Hani Baragwanath academic hospital intensive care unit: comparing outcomes between quinine and artesunate therapy

• Main Author: Mathiba, Rofhiwa
• Format: Others
• Language: en
• Published: 2018
• Online Access: https://hdl.handle.net/10539/25818

A research report submitted to the University of Witwatersrand, Johannesburg in fulfillment for the requirements of the degree of Master of Medicine, 2017 === Background Malaria is a preventable and treatable disease that is a major burden in the African sub-region, accounting for 75% of malaria related deaths globally. Prior to December 2009, quinine has been the therapeutic option of choice for the management of Malaria in our unit. In the non-intensive care unit setting a mortality benefit of artesunate over quinine has been shown by two major trials and thus artesunate is currently therapy of choice for severe malaria. There is paucity of South African data regarding the outcomes of severe malaria patients treated w ith quinine compared to those treated with artesunate in the intensive care unit (ICU). Objectives The aim of this study was to compare the outcomes of patients treated with artesunate versus those treated with quinine, over a four-year period in our ICU. The primary outcome variables were length of stay and mortality, secondary outcomes where hypoglycaemia episodes and neurological outcome as measured by GCS on admission and on discharge. Methods This was a retrospective cohort study of patients with severe malaria treated at Chris Hani Baragwanath Academic Hospital with artesunate or quinine. The study was done in an ICU setting. This included a review of patients treated in the unit from 1st January of 2008 to 31st December 2012. A p value of<0.05 was chosen as a measure of statistical significance. Results The sample consisted of 92 patients. Forty three percent (n=40) received quinine and 57% (n = 52) received artesunate. There was no statistically significant difference between the two drugs in the treatment of severe malaria in our ICU with regards to length of stay (p=0.738), mortality (p=0.246), hypoglycaemia (p= 0.246) and neurological outcome as measured by GCS on admission and discharge (p= 0.357). Conclusion In our intensive care population the difference in outcomes between artesunate and quinine were not statistically significant. Artesunate did not confer an obvious benefit over quinine. Considering the differences in cost, logistical differences associated with the use of the two drugs as well as the emergence of artesunate resistance, we suggest that outcomes of artesunate versus quinine be investigated in other non-endemic regions. === MT 2018