This is not the most recent version of the article. View current version (13 JUN 2012)

Intervention Review

You have free access to this content

Artesunate versus quinine for treating severe malaria

  1. David Sinclair1,*,
  2. Sarah Donegan1,
  3. David G Lalloo2

Editorial Group: Cochrane Infectious Diseases Group

Published Online: 16 MAR 2011

Assessed as up-to-date: 30 JAN 2011

DOI: 10.1002/14651858.CD005967.pub3


How to Cite

Sinclair D, Donegan S, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD005967. DOI: 10.1002/14651858.CD005967.pub3.

Author Information

  1. 1

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

  2. 2

    Liverpool School of Tropical Medicine, Clinical Research Group, Liverpool, Merseyside, UK

*David Sinclair, International Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. davesinkers@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 MAR 2011

SEARCH

This is not the most recent version of the article. View current version (13 JUN 2012)

 

Abstract

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

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.

 

Plain language summary

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

Artesunate reduces death from severe malaria

Severe malaria occurs when infection with the malaria parasite is complicated by serious failure of the body's major organs, and results in over a million deaths every year. Sometimes severe malaria is associated with coma and is known as cerebral malaria. Following cerebral malaria a small proportion of children suffer with long-term neurological disability.

This review of trials assessed the effectiveness of artesunate, compared with the standard treatment quinine. Eight trials involving 1664 adults and 5765 children were identified, from study sites in Asia and Africa.

Treating adults in Asia with artesunate instead of quinine would prevent an extra 94 deaths for every 1,000 patients treated. In trials involving children, the proportion of deaths was lower than in the trials involving adults. This lower risk of death results in a smaller benefit in children than in adults, but would still save an extra 26 lives for every 1,000 children treated.

In the children who survived their illness, there were more neurological problems at the time of hospital discharge in those treated with artesunate than those treated with quinine. However, the majority of these neurological problems had resolved when they were reviewed 28 days later, and at this timepoint there was no difference between the two treatment groups.

Artesunate should be the drug of choice for adults and children with severe malaria worldwide.

 

Resumen

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

Antecedentes

Artesunato versus quinina para el tratamiento del paludismo grave

El paludismo grave da lugar a más de un millón de muertes cada año, la mayoría de ellas en niños menores de cinco años de edad que viven en África subsahariana. Esta revisión analiza si el tratamiento con artesunato en lugar del tratamiento estándar con quinina daría lugar a menos muertes y mejores resultados del tratamiento.

Objetivos

Comparar el artesunato con la quinina en el tratamiento del paludismo grave.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado del Grupo Cochrane de Enfermedades Infecciosas (Cochrane Infectious Diseases Group) CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, ISI Web of Science, el metaRegister of Controlled trials (mRCT), actas de congresos y en las listas de referencias de artículos hasta noviembre 2010.

Criterios de selección

Ensayos controlados aleatorios que compararon el artesunato intravenoso, intramuscular o rectal con la quinina intravenosa o intramuscular para tratar a adultos y niños con paludismo grave que no pueden tomar la medicación por vía oral.

Obtención y análisis de los datos

Dos autores, de forma independiente, evaluaron la elegibilidad y el riesgo de sesgo de los ensayos y extrajeron y analizaron los datos. El resultado primario fue la muerte por todas las causas. Los resultados dicotómicos se resumieron mediante los cocientes de riesgos (CR) y los resultados continuos mediante las diferencias de medias (DM). Cuando resultó apropiado, se combinaron los datos en un metanálisis.

Resultados principales

Se incluyen en esta revisión ocho ensayos con 1664 adultos y 5765 niños.

El tratamiento con artesunato disminuyó significativamente el riesgo de muerte en los adultos (CR 0,61; intervalo de confianza [IC] del 95%: 0,50 a 0,75; 1664 participantes, cinco ensayos) y en los niños (CR 0,76; IC del 95%: 0,65 a 0,90; 5765 participantes, cuatro ensayos),

En los niños, el tratamiento con artesunato aumentó la incidencia de secuelas neurológicas en el momento del alta hospitalaria. En su mayoría estas secuelas fueron transitorias y no se observaron diferencias significativas entre los tratamientos en el seguimiento posterior.

Conclusiones de los autores

Las pruebas apoyan claramente la superioridad del artesunato parenteral sobre la quinina para el tratamiento del paludismo grave en adultos y en niños en diferentes regiones del mundo.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano