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Peter Gottfried Kremsner, Terrie Taylor, Saadou Issifou, Maryvonne Kombila, Yamikani Chimalizeni, Kondwana Kawaza, Marielle K. Bouyou Akotet, Mattias Duscha, Benjamin Mordmüller, Katrin Kösters, Alexander Humberg, R. Scott Miller, Peter Weina, Stephan Duparc, Jörg Möhrle, Jürgen F. J. Kun, Tim Planche, Paktiya Teja-Isavadharm, Julie Anne Simpson, Carsten Köhler, Sanjeev Krishna, A Simplified Intravenous Artesunate Regimen for Severe Malaria–Reply, The Journal of Infectious Diseases, Volume 206, Issue 4, 15 August 2012, Page 622, https://doi.org/10.1093/infdis/jis391
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Tothe Editor—Dondorp and colleagues raise many points that we are grateful to have the chance to address. It should be uncontroversial to assert that it would be of great public benefit to have simpler regimens to treat severe malaria. Dismissing a simpler treatment protocol as providing “minor cost savings” may be disingenuous because it may not, for example, capture the benefit to the single nurse commonly found in charge of a ward with dozens of children with severe malaria. One less intervention for that nurse can free up valuable and potentially life-saving time.
In the past 12 years we, too, have carried out the “largest ever” studies to define severe malaria in African children (SMAC) in 5 countries, prospectively recruiting 26 296 children [1, 2]. Mortality risk varied between 1.4% and 9.5%, with the lowest figures for Blantyre and Lambaréné, the sites where the current trial was implemented. Mortality rates associated with severe malaria can vary several fold among sites: in the Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT) study, 1 site had a mortality risk of 4.3% (18/422 fatal cases; 95% confidence interval [CI], 2.5%–6.7%) [3]; this is comparable to the risks observed in our study (per protocol analysis, 1.2% (2/171 fatal cases; 95% CI, .14%–4.2%).
