Artemether for severe malaria

Examines the effects of treating people with artemether injected intramuscularly compared to treatment with other antimalarial drugs


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, they included 18 randomized controlled trials that recruited 2662 adults and children and were conducted mainly in Africa and Asia.

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.

Findings: 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.

This research is supported by the Department for International Development’s Evidence Building and Synthesis Research Programme which is led by Liverpool School of Tropical Medicine


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]

Artemether for severe malaria

Published 1 January 2014