In this review, researchers from The Cochrane Collaboration examined the effects of treating people that have severe malaria with artemether injected intramuscularly, and compared it to treatment with other antimalarial drugs given intramuscularly or intravenously. After searching for relevant trials up to 9 April 2014, we included 18 randomized controlled trials that recruited 2662 adults and children and were conducted mainly in Africa and Asia.
What is severe malaria and how might artemether injection reduce deaths
Severe malaria is caused by infection with the Plasmodium parasite, which is transmitted to people through the bite of an infected female Anopheles mosquito. It is a serious medical condition and can cause vomiting, anaemia, convulsions and death. People need to be treated as quickly as possible.
Injection of artesunate is recommended by the World Health Organization (WHO) for treating adults and children that have severe malaria as trials have shown that it results in fewer deaths compared to quinine treatment. Artemether is an alternative artemisinin derivative but is only available as a pre-mixed oil-based solution for intramuscular injection. Artemether is now widely available and is used in many African countries, although it is not specifically recommended by the WHO.
What the research says
Artemether versus quinine:
For children in Africa, intramuscular artemether is probably as good as quinine at preventing deaths from severe malaria (moderate quality evidence). Artemether may shorten recovery time from coma by about five hours (low quality evidence), and may reduce the number of children with signs of brain damage at the time of hospital discharge (low quality evidence).
In older children (
Artemether versus artesunate:
In adults from Asia, artesunate probably prevents more deaths than artemether (moderate quality evidence), but no trials have been conducted in young children from Africa.
Although there is a lack of direct evidence comparing artemether with artesunate, artemether is probably less effective than artesunate at preventing deaths from severe malaria. In circumstances where artesunate is not available, artemether is an alternative to quinine.
Esu, E.; Effa, E.E.; Opie, O.N.; Uwaoma, A.; Meremikwu, M.M. Artemether for severe malaria. Cochrane Database of Systematic Reviews (2014) Issue 9, Art. No.: CD010678. [DOI: 10.1002/14651858.CD010678.pub2]