Artesunate versus quinine for treating severe malaria.
Abstract
Severe malaria kills over a million people every year. The annual death toll can be as high as one in a 100 children under the age of five. Severe malaria occurs when infection with the malaria parasite is complicated by serious failure of the body's major organs. Sometimes it is associated with coma (known as cerebral malaria). Following cerebral malaria a small proportion of children suffer with long-term neurological disability.
Quinine, the standard treatment for severe malaria, often causes adverse effects. In most people symptoms are mild; less common but more serious adverse effects include low blood sugar and heart rhythm disturbances. Regular glucose measurement and a heart trace are therefore advised when quinine is given by injection. Lack of resources may not permit this monitoring in some settings.
Artesunate is generally well tolerated, safe, and does not require any monitoring. Artesunate comes from a family of drugs known as the artemisinin derivatives. Another drug from this group, artemether, has shown no reduction in death compared to quinine. Artemether absorption is erratic and unreliable. By contrast, artesunate levels peak reliably and predictably within an hour.
The review of trials assessed the effectiveness of artesunate versus quinine. Six trials involving 1938 people (1664 adults and 274 children) were identified, all undertaken in Asia. Treatment with artesunate significantly reduced the risk of death. It also reduced the time taken to clear parasites from the blood and reduced the number of people with low blood sugar during follow up in trials where this was routinely measured. There was no evidence to say if the drug is effective in children in Africa, in whom most deaths from severe malaria occur.
Citation
Jones, K.L.; Donegan, S.; Lalloo, D.G. Artesunate versus quinine for treating severe malaria. Cochrane Database of Systematic Reviews (2007) (Issue 4) Art. No.: CD005967. [DOI: 10.1002/14651858.CD005967.pub2]