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Meta-Analysis
. 2012 Jun 13;2012(6):CD005967.
doi: 10.1002/14651858.CD005967.pub4.

Artesunate versus quinine for treating severe malaria

David Sinclair  1 , Sarah Donegan, Rachel Isba, David G Lalloo
Affiliations
Meta-Analysis

Artesunate versus quinine for treating severe malaria

David Sinclair et al. Cochrane Database Syst Rev. .

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.

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Conflict of interest statement

Dr David Lalloo was part of the data and safety monitoring committee for the two Dondorp trials. This committee is independent, does not run or gain anything from the trial, and has a main role of protecting participants.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Forest plot of comparison: 1 Artesunate vs quinine, outcome: 1.1 Death: participant age [Relative effect].
3
3
Forest plot of comparison: 1 Artesunate vs quinine, outcome: 1.9 Neurological sequelae at discharge.
4
4
Forest plot of comparison: 1 Artesunate vs quinine, outcome: 1.15 Hypoglycaemia episodes: by age of participants.
1.1
1.1. Analysis
Comparison 1 Artesunate vs quinine, Outcome 1 Death: participant age.
1.2
1.2. Analysis
Comparison 1 Artesunate vs quinine, Outcome 2 Death: time since admission to hospital [sensitivity analysis].
1.3
1.3. Analysis
Comparison 1 Artesunate vs quinine, Outcome 3 Death: intravenous vs intramuscular artesunate [sensitivity analysis].
1.4
1.4. Analysis
Comparison 1 Artesunate vs quinine, Outcome 4 Neurological sequelae at discharge.
1.5
1.5. Analysis
Comparison 1 Artesunate vs quinine, Outcome 5 Neurological sequelae at day 28.
1.6
1.6. Analysis
Comparison 1 Artesunate vs quinine, Outcome 6 Coma recovery time (hours).
1.7
1.7. Analysis
Comparison 1 Artesunate vs quinine, Outcome 7 Time to hospital discharge (days).
1.8
1.8. Analysis
Comparison 1 Artesunate vs quinine, Outcome 8 Fever clearance time (hours).
1.9
1.9. Analysis
Comparison 1 Artesunate vs quinine, Outcome 9 Parasite clearance time (hours).
1.10
1.10. Analysis
Comparison 1 Artesunate vs quinine, Outcome 10 Hypoglycaemia episodes: by age of participants.
1.11
1.11. Analysis
Comparison 1 Artesunate vs quinine, Outcome 11 Hypoglycaemia episodes: by method of monitoring.
See this image and copyright information in PMC

Update of

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