N-acetylcysteine as adjunctive treatment in severe malaria: a randomized, double-blinded placebo-controlled clinical trial
| Autor: | Arjen M. Dondorp, Ronnatrai Ruangveerayut, Mahatab Uddin Hasan, M. Gofranul Hoque, M. Ridwanur Rahman, Nicholas P. J. Day, Emran Bin Yunus, Sue J. Lee, L. Jackson Roberts, Kevin P. Moore, M. Abul Faiz, Nicholas J. White, Prakaykaew Charunwatthana, Paul N. Newton, Richard J. Maude, Sasithon Pukrittayakamee |
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| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
business.industry Placebo-controlled study Parasitemia Critical Care and Intensive Care Medicine Placebo medicine.disease Article law.invention Surgery chemistry.chemical_compound Randomized controlled trial chemistry law Artesunate Internal medicine Intensive care Adjunctive treatment parasitic diseases medicine business Malaria |
| Zdroj: | Critical care medicine. 37(2) |
| ISSN: | 1530-0293 0090-3493 |
| Popis: | Objective—Markers of oxidative stress are reported to be increased in severe malaria. It has been suggested that the antioxidant N-acetylcysteine (NAC) may be beneficial in treatment. We studied the efficacy and safety of parenteral N-acetylcysteine as an adjunct to artesunate treatment of severe falciparum malaria. Design—A randomized double-blind placebo controlled trial on the use of high dose intravenous NAC as adjunctive treatment to artesunate. Setting—A provincial hospital in Western Thailand and a tertiary referral hospital in Chittagong, Bangladesh. Patients—One hundred and eight adult patients with severe falciparum malaria. Interventions—Patients were randomized to receive N-acetylcysteine or placebo as adjunctive treatment to intravenous artesunate. Measurements and main results—A total of 56 patients were treated with NAC and 52 received placebo. NAC had no significant effect on mortality, lactate clearance times (p=0.74) or coma recovery times (p=0.46). Parasite clearance time was increased from 30h (range 6h to 144h) to 36h (range 6h to 120h) (p=0.03), but this could be explained by differences in admission parasitemia. Urinary F2-isoprostane metabolites, measured as a marker of oxidative stress, were increased in severe malaria compared to patients with uncomplicated malaria and healthy volunteers. Admission red cell rigidity correlated with mortality, but did not improve with NAC. Conclusion—Systemic oxidative stress is increased in severe malaria. Treatment with Nacetylcysteine had no effect on outcome in patients with severe falciparum malaria in this setting. |
| Databáze: | OpenAIRE |
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