Malu CK, Kahamba DM, Walker TD, Mukampunga C, Musalu EM, Kokolomani J, Mayamba RM, Wilmshurst JM, Dubru JM, Misson JP.
1Service of Child Neurology, Kinshasa University Teaching Hospital, Democratic Republic of Congo.
J Child Neurol. 2013 Jul 31. [Epub ahead of print]

In Sub-Saharan Africa, intrarectal diazepam is the first-line anticonvulsant mostly used in children. We aimed to assess this standard care against sublingual lorazepam, a medication potentially as effective and safe, but easier to administer. A randomized controlled trial was conducted in the pediatric emergency departments of 9 hospitals. A total of 436 children aged 5 months to 10 years with convulsions persisting for more than 5 minutes were assigned to receive intrarectal diazepam (0.5 mg/kg, n = 202) or sublingual lorazepam (0.1 mg/kg, n = 234). Sublingual lorazepam stopped seizures within 10 minutes of administration in 56% of children compared with intrarectal diazepam in 79% (P < .001). The probability of treatment failure is higher in case of sublingual lorazepam use (OR = 2.95, 95% CI = 1.91-4.55). Sublingual lorazepam is less efficacious in stopping pediatric seizures than intrarectal diazepam, and intrarectal diazepam should thus be preferred as a first-line medication in this setting. KEYWORDS: Africa, Sublingual Lorazepam, children, convulsions, emergency treatment

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