Artesunate versus quinine for treating severe malaria (Review)

Sinclair, David, Donegan, Sarah, Isba, Rachel and Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200 (2012) 'Artesunate versus quinine for treating severe malaria (Review)'. Cochrane Database of Systematic Reviews, Issue 6, CD005967.

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Abstract

Background

Severe malaria results in over a million deaths every year, most of them in children aged under five years and living in sub-Saharan Africa. This review examines whether treatment with artesunate, instead of the standard treatment quinine, would result in fewer deaths and better treatment outcomes.

Objectives

To compare artesunate with quinine for treating severe malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library),MEDLINE, EMBASE, LILACS, ISI Web of Science, the metaRegister of Controlled trials (mRCT), conference proceedings, and reference lists of articles to
November 2010.

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 independently assessed the eligibility and risk of bias of trials, and extracted and analysed data. The primary outcome was all-cause death. Dichotomous outcomes were summarized using risk ratios (RR) and continuous outcomes by mean differences (MD). Where appropriate, we combined data in meta-analyses.

Main results

Eight trials enrolling 1664 adults and 5765 children are included in this review.
Treatment with artesunate significantly reduced the risk of death both in adults (RR 0.61, 95% Confidence Interval (CI) 0.50 to 0.75; 1664 participants, five trials) and children (RR 0.76, 95% CI 0.65 to 0.90; 5765 participants, four trials) In children, treatment with artesunate increased the incidence of neurological sequelae at the time of hospital discharge. The majority of these sequelae were transient and no significant difference between treatments was seen at later follow up.

Authors’ conclusions

The evidence clearly supports the superiority of parenteral artesunate over quinine for the treatment of severe malaria in both adults and children and in different regions of the world.

Item Type:	Article
Corporate Authors:	Cochrane Infectious Diseases Group
Additional Information:	This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2012, Issue 6, CD005967. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.
Subjects:	QV Pharmacology > QV 38 Drug action. WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Digital Object Identifer (DOI):	https://doi.org/10.1002/14651858.CD005967.pub4
Related URLs:	http://www.cochrane.org/cochrane-reviews
Depositing User:	Martin Chapman
Date Deposited:	25 Oct 2012 14:34
Last Modified:	21 Nov 2024 11:02
URI:	https://archive.lstmed.ac.uk/id/eprint/3075

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