Intervention Review

Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria

  1. Christy AN Okoromah2,*,
  2. Bosede B Afolabi3,
  3. Emma CB Wall4

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 13 APR 2011

Assessed as up-to-date: 22 NOV 2010

DOI: 10.1002/14651858.CD004615.pub3

Database Title

Additional Information

How to Cite

Okoromah CAN, Afolabi BB, Wall ECB. Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD004615. DOI: 10.1002/14651858.CD004615.pub3.

Author Information

  1. 2

    College of Medicine, University of Lagos, Department of Paediatrics and Child Health, Lagos, Lagos, Nigeria

  2. 3

    University of Lagos, Department of Obstetrics and Gynaecology, Lagos, Nigeria

  3. 4

    Liverpool School of Tropical Medicine, International Health Group, Liverpool, UK

*Christy AN Okoromah, Department of Paediatrics and Child Health, College of Medicine University of Lagos, Idi-Araba, Surulere, Lagos, Lagos, PMB 12003, Nigeria. faimer2004_christy@yahoo.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 13 APR 2011

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (55K)Standard (202K)Full (234K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Cerebral oedema occurs with cerebral malaria, and some clinicians think osmotic diuretics, such as mannitol or urea, may improve outcomes.

Objectives

To compare mannitol or urea to placebo or no diuretic for treating children or adults with cerebral malaria.

Search methods

We searched the Cochrane Infectious Diseases Group Specialized Register (Issue 4, 2010), CENTRAL (The Cochrane Library Issue 12, 2010), MEDLINE (1966 to November 2010), EMBASE (1974 to November 2010), LILACS (1982 to November 2010), and the reference lists of articles. We contacted relevant organizations and researchers.

Selection criteria

Randomized or quasi-randomized controlled trials comparing mannitol or urea to placebo or no treatment in children and adults with cerebral malaria. Primary outcomes were death, life-threatenining sequelae and major neurological sequelae at six months.

Data collection and analysis

Two authors applied the inclusion criteria, assessed risk of bias, and extracted data independently.

Main results

One trial met the inclusion criteria, comparing mannitol 20% to saline placebo in 156 Ugandan children. Allocation was concealed. No difference in mortality, time to regain consciousness, or neurological sequelae were detected.

Authors' conclusions

There are insufficient data to know what the effects of osmotic diuretics are in children with cerebral malaria. Larger, multicentre trials are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Mannitol and other osmotic diuretics as adjuncts for treating cerebral malaria

Cerebral malaria can lead to coma and death, even when the patient is given anti-malarial drugs. Death is caused by the malaria parasites in the brain that cause brain swelling, leading to pressure in the brain. Mannitol is a drug that sometimes reduces brain swelling in other situations, such as traumatic head injury.

We searched for studies testing mannitol given in addition to anti-malarial drugs in children with cerebral malaria. One study, carried out in Uganda, was found. A total of 156 children were randomly divided to receive either mannitol or placebo (saline solution) in addition to quinine, which is an anti-malarial drug. No difference in either the numbers of deaths, or the time to recover from coma was found in this study. More studies are needed, but from this review mannitol cannot be currently recommended for use in cerebral malaria.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Mannitol與其他的滲透壓型利尿劑來當作添加劑治療腦性瘧疾

對於腦性瘧疾而言，主要的治療方法為腸外的抗瘧疾藥物。對於腦性瘧疾而言，醫師們會使用Mannitol與尿素來當作輔助療法，但是世界衛生組織卻不推薦它們。

目標

對於治療患有腦性瘧疾的兒童與成年人而言，要將mannitol或是尿素與安慰劑或是不採取治療進行比較。

搜尋策略

我們搜尋Cochrane Infectious Diseases Group Specialized Register (July 2006)、 CENTRAL (Cochrane Library Issue 3, 2006)、 MEDLINE (1966年 – 2006年7月)、 EMBASE (1974 – 2006年7月)、 LILACS (1982 – 2006年7月)、以及文章的參考資料清單. 我們也與本領域研究人員及相關機構聯絡。

選擇標準

對於治療患有腦性瘧疾的兒童與成年人而言，這些隨機與半隨機對照試驗將mannitol或是尿素與安慰劑或是不採取治療進行了比較。

資料收集與分析

沒有任何試驗符合收集的標準。

主要結論

沒有任何試驗符合收集的標準。

作者結論

經過我們的確認，對於治療腦性瘧疾而言，沒有任何隨機或是半隨機對照試驗可以支持或是反對在臨床的實務當中使用mannitol或是尿素來當作添加劑。這可能表示我們需要1項多中心的試驗。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

View Full Article (HTML) Summary (55K)Standard (202K)Full (234K)