Artesunate versus quinine for treating severe malaria

Artesunate compared with quinine for the treatment of severe malaria in adult patients managed in an intensive care unit: A retrospective observational study

Background

There are limited South African data on the outcomes of patients with severe malaria treated with quinine compared with those treated with artesunate in the intensive care unit (ICU).

Objectives

To compare the outcomes of adult patients treated with artesunate against those treated with quinine in the ICU. Primary outcome variables are length of stay (LOS) in the ICU and mortality. Secondary outcomes include the incidence of hypoglycaemic episodes and neurological outcomes.

Methods

This was a retrospective cohort study of patients with severe malaria treated at a multidisciplinary ICU with artesunate or quinine from 1 January 2008 to 31 December 2012.

Results

Of the 92 patients included in the study, 63 (69.2%) were male. The mean age in the quinine and artesunate groups was 36.2 years and 40.5 years, respectively (p=0.071). Most (98.6%) of the patients with a positive travel history had visited a malaria-endemic region. Of the 53 patients tested for HIV infection, 71.7% tested positive (p=0.520). The average CD4+ cell count of HIV-positive patients treated with quinine was 200 cells/µL compared with 217.17 cells/µL for those treated with artesunate (p=0.875). The mean APACHE II score at admission was 20.85 and 19.62 in the quinine group and artesunate group, respectively (p=0.380). The median LOS was 5 days (range 1 - 27). Mortality was 15.4% in the quinine group and 7.7% in the artesunate group (p=0.246).

Conclusion

A statistically insignificant mortality difference was observed in outcomes of the two treatment groups in this retrospective, single-centre cohort study.

Contributions of the study

Intravenous artesunate is currently the preferred treatment in the management of patients with severe malaria. However, there are limited local data on the outcomes of artesunate v. quinine therapy for the management of severe malaria in highly monitored clinical environments in non-endemic regions of South Africa.We describe clinical characteristics, management and outcomes of patients with severe malaria treated with quinine and those treated with artesunate in the ICU in a non-endemic region.

Effects of capecitabine and vinorelbine on cell proliferation, metabolism and COX2 and p16 expression in breast cancer cell lines and solid tumour tissues

BACKGROUND

Capecitabine is a recently developed oral antineoplastic prodrug of 5-fluorouracil. It has demonstrated a favorable tolerability profile, with low incidence of myelosuppression. Vinorelbine, a third generation vinca alkaloid, works by inhibiting mitosis and interfering with cells' ability to synthesize DNA and RNA. The present study investigates the therapeutic value of single use capecitabine on solid tumour tissues in vitro using breast cancer cell lines and as reference. The data is to be compared with the use of vinorelbine which is a conventionally applied drug for advanced breast cancer patients.

METHODS

The trucut biopsies of 35 metastatic breast tumour patients were obtained. The tissues were cultured for 24h. Capecitabine and vinorelbine were added according to the corresponding groups to be cultured by another 24h. Plain medium was added for control group. The two cell lines chosen were BT-783 and MB-MDA-231 to act as a reference group. The metabolic rate of the tissues and cell lines were measured by ATP bioluminescence assay and the proliferation rate was measured by WST-1. The level of COX2 and p16 after capecitabine and vinorelbine treatment was assessed with immunohistochemical methods.

RESULTS

One-way ANOVA revealed lower metabolic rate in test groups than control in cell lines and tumour tissues. WST-1 showed similar trend in both cell lines. COX2 and p16 staining showed decreases in cell size and number after drug use.

CONCLUSIONS

Capecitabine demonstrated similar inhibitory effects as vinorelbine in breast cancer cell lines and solid tumour tissues at decreasing cell proliferation and metabolism as well as decreasing the expression of metabolic proteins and tumor suppressor genes. Capecitabine also has the added benefits of convenient oral administration and lower cost.