Prognostic Efficacy Assessment of ACT Therapy and Quinine in Severe Falciparum Malaria Saumya Gupta, Arati Lalchandani, Vishal Gupta, *Rajeev Gupta Department of General Medicine, *Department of General Pediatrics, Ganesh Shankar Vidyarthi Memorial Medical College (GSVM Medical College), Kanpur, *King George Medical University, Lucknow. ABSTRACT In this study, the changes in prognostic indicators such as haemoglobin levels, serum lactate levels, liver function tests, blood sugar levels and glassgow coma scale in patients of severe falciparum malaria treated with Artesunate combination therapy and Quinine have been observed. One hundred patients of severe falciparum malaria were selected from medicine indoor wards. The patients were randomly assigned to artesunate based combination therapy or quinine based therapy. Prognostic parameters like haemoglobin, glasgow coma scale, serum lactates, liver function test and blood sugar levels were monitored. The present study suggests that artesunate is an effective alternative to quinine in the treatment of severe malaria.The mortality, incidence of posttreatment hypoglycemia, coma recovery time, time to normalization of plasma lactate levels and liver function tests, variability in Haemoglobin were not found to be statistically significant. Occurrence of hypoglycemia and hearing disturbances in quinine treatment group was found to be statistically significant. KEY WORDS: artesunate combination therapy, infectious disease, malaria, pharmacotherapy, quinine leucocytosis, severe anaemia, coagulopathy and Hyperparasitemia are observed . A variety of [2,7] antimalarial medications are available. Severe malaria is treated with intravenous or intramuscular quinine or, since the mid-2000s, the artemisinin derivative artesunate, which is superior to quinine in both children and adults. In patients with severe malaria, artesunate combination therapy is recommended. Certain parameters like hypoglycemia, acidosis, glassgow coma scale, liver function tests and serial changes in hematocrit guide towards the severity of underlying disease and response to treatment and hence should be monitored throughout the course of disease . This study planned to compare these [1,2,3] parameters in two treatment groups i.e. artesunte in combination with clindamycin and quinine . [4,5] Hypoglycemia, an important and common complication of severe malaria, is associated with poor prognosis . It results from a failure of hepatic [6] gluconeogenesis and an increase in the consumption of glucose by both host and, to a much lesser extent, the malarial parasites. The situation is further compounded by the use of quinine (and quinidine), which is a powerful stimulant of pancreatic insulin secretion. Hyperinsulinemic hypoglycemia is especially troublesome in pregnant women receiving quinine treatment. In severe disease, the clinical diagnosis of hypoglycemia is difficult: the usual INTRODUCTION: Malaria results from the multiplication of plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache. It may lead to death in severe cases. It is common in tropical and subtropical regions. Severe disease is largely caused by Plasmodium falciparum while the disease caused by Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae is generally a milder disease that is rarely fatal . Plasmodium knowlesi is [1,2] a zoonosis that causes malaria in macaques but can also infect humans. Malaria is transmitted through the bites of infected mosquitoes. Features indicating poor prognosis in severe falciparum malaria- clinically are marked agitation, hyperventilation (respiratory distress), hypothermia(36.5c), bleeding, deep coma, repeated convulsions, anuria and shock. Hypoglycemia (<2.2mmol/l), hyperlactatemia (>5mmol/l), acidosis, elevated serum creatnine, total bilirubin, liver enzymes,muscle enzymes, urate; --------------------------------------------------------------- Corresponding Author: Dr Saumya Gupta, Assistant Professor, Department of General Medicine, Institute of Medical Sciences-BHU, Varanasi - 221005 (India) Phone No.: 9889595056 E-mail: g_saumya@yahoo.com Original Research Article People’s Journal of Scientific Research July 2019; Volume 12, Issue 2 20