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Artesunate versus quinine for treating severe malaria

Jones, KL; Donegan, S and Lalloo, DG (2007) Artesunate versus quinine for treating severe malaria. Cochrane Database of Systematic Reviews (4). Article Number: CD005967. ISSN 1469-493X

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Abstract

Background Severe malaria kills over a million people every year. We sought evidence of superiority of artesunate compared with the standard treatment quinine. Objectives To compare artesunate with quinine for treating severe malaria. Search strategy We searched the Cochrane Infectious Diseases Group Specialized Register (January 2007), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE (1966 to January 2007), EMBASE (1974 to January 2007), LILACS (1982 to January 2007), ISI Web of Science (1945 to January 2007), the metaRegister of Controlled trials (mRCT), conference proceedings, and reference lists of articles. We contacted researchers and the World Health Organization. Selection criteria Randomized controlled trials comparing intravenous, intramuscular, or rectal artesunate with intravenous or intramuscular quinine for treating adults and children with severe malaria who are unable to take medication by mouth. Data collection and analysis Two authors assessed the eligibility and methodological quality of trials, extracted and analysed data, and drafted the review. The third author contributed to the design and writing of the review. Death was the primary outcome. Dichotomous outcomes were summarized using relative risks and continuous outcomes by mean differences. Where appropriate, we combined data in meta-analyses. Heterogeneity was investigated for the primary outcome using subgroup analyses. Main results Six trials enrolling 1938 participants (1664 adults and 274 children) met our inclusion criteria. All six trials were conducted in Asia, and only one small trial enrolled only children. Five trials used intravenous artesunate and one trial intramuscular artesunate; all six used intravenous quinine. Treatment with artesunate significantly reduced the risk of death (RR 0.62, 95% CI 0.51 to 0.75; 1938 participants, 6 trials), reduced parasite clearance time (WMD 8.14 h, 95% CI 11.55 to 4.73; 292 participants, 3 trials), and hypoglycaemia detected by routine monitoring (RR 0.46, 95% CI 0.25 to 0.87; 185 participants, 2 trials). There was no evidence of a difference in neurological sequelae, coma recovery time, time to hospital discharge, fever clearance time, or adverse effects other than hypoglycaemia. Authors' conclusions Intravenous artesunate is the drug of choice for adults with severe malaria, particularly if acquired in Asia. This review did not identify sufficient data to make firm conclusions about the treatment of children or the effectiveness of intramuscular artesunate. There is an urgent need to compare the effects of artesunate with quinine in African children with severe malaria. The applicability of these results to Asian children and the ethics of further research are points of debate.

Item Type:Article
Additional Information:This version first published online: 17 October 2007 in Issue 4, 2007. 31 pages. ADDITIONAL CITATION INFORMATION This record should be cited as: Jones KL, Donegan S, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005967. DOI: 10.1002/14651858.CD005967.pub2.
Uncontrolled Keywords:malaria; artesunate; quinine; systematic; randomized controlled trials; intravenous; SEVERE FALCIPARUM-MALARIA; EFFICACY
Subjects:R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
DOI:10.1002/14651858.CD005967.pub2
Publisher's Statement:This review is published as a Cochrane Review in The Cochrane Library 2008, Issue 3. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the Review.
Refereed:Yes
Status:Published
ID Code:804
Deposited On:14 Aug 2008 10:32
Last Modified:16 Apr 2013 14:50

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