Arginine Malaria Trial: Study of Adjunctive Arginine in Falciparum Malaria

Inclusion criteria

• Ages 18-60 years
• P. falciparum parasitemia (1,000-100,000 parasites/ul).
• Clinical syndrome consistent with malaria associated with documented fever (axillary temperature > 38℃) or self-reported history of fever in the last 48 hours with no other cause present
• Commenced oral quinine ≤ 18 hours prior to scheduled commencement of arginine
• An indication for hospital admission (eg relative cannot look after/supervise treatment at home but not having any warning signs or severe malaria criteria in "exclusion criteria" below)
• Informed consent obtained

Exclusion criteria

• Pregnancy or lactation
• Mixed infection with P. falciparum and P. vivax
• Warning signs of altered mental state and inability to sit unaided
• Features of severe/complicated malaria
• Diabetes
• Systolic blood pressure (BP) < 100 mmHg
• Serious underlying disease (cardiac, hepatic, kidney)
• Initial iSTAT test showing any of the following values:

• glucose < 4 mmol/L;
• K+ ≥ 4.2 meq/L;
• Cl- > 106 meq/L;
• HCO3- < 20 meq/L.
• Known allergy to L-arginine
• Concurrent therapy with any of the following medications:

• spironolactone;
• oral nitrates;
• phosphodiesterase inhibitor (eg sildenafil [Viagra]);
• alpha-blocking antihypertensive agents (eg prazosin);
• L-arginine.