The Efficacy of Artesunate Monotherapy Compared to Quinine-Azithromycin Combination for Treatment of Uncomplicated Falciparum Malaria in Children

Department of Health, Republic of Indonesia had changed the standard treatment of falciparum malaria into artesunate-amodiaquine combination since the end of 2004. We need to find alternative drug if this combination drug is not available. This study was aimed to compare the efficacy of artesunate monotherapy with quinine-azithromycin combination, as a treatment of uncomplicated falciparum malaria in children. A randomized open label clinical trial was conducted on July to August 2007 at Mandailing Natal, Sumatera Utara Province, in 5 to 18 years old children with positive P. falciparum from the peripheral blood smear. Group I received artesunate monotherapy orally and group II received quinine combined with azithromycin orally. Parasitemia was counted on day 0, 2, 7, and 28. The cure rate was 100% and no recrudescence for both group on day 2, 7, and 28 (P=0,001). Headache, vomiting, and tinnitus adverse event was found in 14, 7 and 4 children in group II (P=0,0001; 0,027; 0,039) respectively. Both of drugs can be used as alternative treatment for uncomplicated falciparum malaria in children, but combination of quinine-azithromycin have more serious adverse reactions than artesunate monotherapy.