Artesunate versus quinine for treating severe malaria
David Sinclair and co-authors have updated this review, first published in 2007, by adding a new large multicentre trial of African children published in the Lancet in 2010 to the existing 8 trials. Severe malaria can be associated with cerebral malaria, which affects the brain and can lead to long-term disability. More than a million people die each year from severe malaria, the majority in Sub-Saharan Africa. Artesunate was recommended as the preferred treatment for adults with severe malaria by the World Health Organization (WHO) in 2006, but there was insufficient evidence at the time to recommend a change from the standard treatment of quinine in children. The review now includes a total of 1664 adults and 5765 children, from a variety of settings across Africa and Asia. According to the results, taking artesunate reduces the risk of death by 39% in adults and 24% in children. The authors conclude that quinine should no longer be the drug of choice for treating severe malaria. Although more children given artesunate suffered neurological problems compared to those given quinine, these were largely resolved within a month of treatment, and were outweighed by the increase in survival rates. Intravenous artesunate is now being recommended as the treatment of choice for adults and children with severe malaria anywhere in the world.
Cochrane Database of Systematic Reviews (2011), Issue 3. Art. No.: CD005967. [DOI: 10.1002/14651858.CD005967.pub3]